J Korean Ophthalmol Soc.  2014 Jul;55(7):1099-1105.

A Case of Optic Disc Hemorrhage Associated with Buried Optic Nerve Head Drusen

• Choi WG
• Jang JH

Abstract

PURPOSE
We report a case of optic disc hemorrhage associated with buried optic nerve head drusen in a pediatric patient.
CASE SUMMARY
A 10-year-old female visited our clinic with a floating sensation in her left eye, 2 days in duration. Best corrected visual acuity was 1.0 in both eyes. Intraocular pressure, light reflex, relative afferent pupillary defect and color vision were normal. The patient showed a small optic disc with blurred, irregular margins in both eyes, and optic disc hemorrhage in the left eye on fundus examination. Visual field examination revealed an enlarged blind spot in the left eye. To achieve correct diagnosis, brain MRI was performed and revealed normal findings. On spectral-domain optical coherence tomography (OCT), hyper-reflective and heterogeneous mass like lesions were found with buried optic nerve head drusen.
CONCLUSIONS
In general, optic nerve head drusen, has a good prognosis; however, visual field defects or hemorrhagic complications can occur, therefore, correct diagnosis and regular follow-up are necessary.

Keyword

Buried optic nerve drusen; Optic disc hemorrhage; Pediatrics

MeSH Terms

Brain
Child
Color Vision
Diagnosis
Female
Follow-Up Studies
Hemorrhage*
Humans
Intraocular Pressure
Magnetic Resonance Imaging
Optic Disk*
Pediatrics
Prognosis
Pupil Disorders
Reflex
Sensation
Tomography, Optical Coherence
Visual Acuity
Visual Fields

Figure

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  Figure 1. Visual field tests at the first visit. These show normal in the right eye (A) and the enlargement of blind spot in the left eye (B). POS = positive; NEG = negative.

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  Figure 2. Fundus photographs at the first visit (A, B). These show bilateral small optic disc with blurred, irregular margin, suggestive of optic nerve head drusen. The arrowhead indicates deep peripapillary hemorrhage. The arrow indicates splinter hemorrhage.

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  Figure 3. Images showing multiple buried optic disc drusen within small optic disc of the right eye (A-E) and left eye (F-J). White horizontal lines in fundus photographs (A, F) indicate the horizontal cross sections level of the optical coherence tomography (OCT) scan (B-E, G-J). E and J images show three-dimensional image-OCT on center of optic disc. These reveal buried optic nerve head drusen with a subretinal hyperreflective mass like lesion (B-D, G, white arrows) with optic disc elevation in both eyes. Deep peripapillary hemorrhage and vitreous hemorrhage reflect hyporeflectivity on the subretinal and preretinal space in the left eye.

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  Figure 4. Retinal nerve fiber layer (RNFL) measurement using spectralis optical coherence tomography (OCT) of both eyes. (A) The RNFL thickness is increased in all sections except for nasal section by the underlying buried optic nerve head drusen in the right eye. (B) Because of deep peripapillary hemorrhage in the left eye, the RNFL thickness cannot be measured accurately. ILM = inner limiting membrane; TS = superotemporal; NS = superonasal; T = temporal; G = general; N = nasal; TI = inferotemporal; NI = inferonasal; TMP = temporal; SUP = superior; NAS = nasal; INF = inferior.

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  Figure 5. Fundus photograph and visual field test after 1 month. (A) Fundus photograph shows the disappearance of peripapillary hemorrhage. (B) Visual field test shows the enlargement of blind spot, not much change comparing with visual field test of the first visit. POS = positive; NEG = negative.

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  Figure 6. Retinal nerve fiber layer (RNFL) measurement using spectralis optical coherence tomography (OCT) of the left eye after the disappearance of peripapillary hemorrhage, after 1 month. The RNFL thickness is increased in all sections except for nasal section by the underlying buried optic nerve head drusen. ILM = inner limiting membrane; TS = superotemporal; NS = superonasal; T = temporal; G = general; N = nasal; TI = inferotemporal; NI = inferonasal; TMP = temporal; SUP = superior; NAS = nasal; INF = inferior.

Reference

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