A 21-year-old woman was referred for possible papilledema after a routine examination. She had a visual acuity of 20/20 OU, normal Humphrey visual fields, and normal color vision. A dilated examination revealed elevated optic nerve heads with significant surrounding peripapillary opaque haloes, without hyperemia or obscuration of the retinal vasculature, suggesting pseudopapilledema. Optic disc drusen were visible on the nasal portion of the optic disc (Figure, B) in the left eye on fundus photography and both eyes with fundus autofluorescence and enhanced-depth imaging–optical coherence tomography. Enhanced-depth imaging–optical coherence tomography of the optic disc also demonstrated peripapillary hyperreflective ovoid masslike structures with small hyperreflective dots. A review of old records indicated that these fundus changes had been present 10 years prior to presentation. Peripapillary changes associated with optic disc drusen can be impressive and extensive, but the absence of optic disc hyperemia, stability over time, and use of optic nerve imaging can help in differentiating it from true papilledema.1,2
Nichani P, Micieli JA. Peripapillary Haloes Associated With Optic Disc Drusen. JAMA Ophthalmol. 2021;139(2):e204083. doi:10.1001/jamaophthalmol.2020.4083
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