Pseudodrusen of the optic disc: Papilledema simulating buried drusen of the optic nerve head

The distinction between true papilledema and pseudopapilledema rests on characteristics of the optic disc when examined ophthalmoscopically. Buried disc drusen frequently simulate papilledema and often result in misdirected diagnostic maneuvers in search of a cause for presumed intracranial hypertension. When an elevated optic disc exhibits an irregular, “lumpy, bumpy” border, a diagnosis of buried drusen of the optic nerve is usually made. We report a case with papilledema secondary to increased intracranial pressure in which the margins of the swollen optic disc presented this lumpy, bumpy border characteristic of buried drusen. The lumpy character of the disc border disappeared with resolution of the papilledema, and ultrasonography demonstrated the absence of any buried drusen. Other characteristics of papilledema, including extension of the disc swelling into the peripapillary nerve fiber layer, telangiectasia of the superficial vessels of the optic disc, and obscuration of the retinal vessels as they crossed the margins of the optic disc, provided strong evidence of true papilledema and remain the most reliable findings allowing a distinction between true papilledema and pseudopapilledema.