The color image of the right optic disc reveals an irregular disc border, and the left optic disc has temporal disc edema and a superficial hemorrhage over the temporal disc margin. The autofluorescence studies show well-defined round hyperautofluorescent spots over the disc in each eye. The OCTs of the discs show reflective bodies with shadowing. Six weeks later, the disc edema and hemorrhage had resolved, and there was superior disc pallor.
This patient had optic disc drusen in each eye and anterior ischemic optic neuropathy (AION) in the left eye. She did not have systemic symptoms to suggest giant cell arteritis, and her laboratory testing revealed a normal sed rate and C-reactive protein and an unremarkable CBC. Several reports have revealed an association between AION and optic disc drusen.1,2 Presumably the drusen interfere with arterial blood flow and predispose to a blockage. Most patients with AION and optic disc drusen have an altitudinal visual field defect, but one-fifth of the patients in the series reported by Purvin et al. had a cecocentral scotoma. In comparison to patients who had non-arteritic AION without optic disc drusen, those with disc drusen tended to be younger, to have had preceding episodes of transient visual obscuration, and had a more favorable visual outcome.
Diabetic papillopathy is a consideration in this setting. This condition is usually unilateral, but bilateral presentation is quite common. These patients generally do not experience a significant change in vision. Spontaneous resolution in 4-6 weeks is typical.
1. Purvin V, King R, Kawasaki A, Yee R. Anterior ischemic optic neuropathy in eyes with optic disc drusen. Archives of Ophthalmology 2004; 122:48-53.
2. Megur B, Megur D, Megur U, Reddy S. Anterior ischemic optic neuropathy in association with optic nervehead drusen. Indian Journal of Ophthalmology 2014; 62:829-831.
