Acute visual loss followed by optic disc atrophy mimicking o
Published in BMC Ophthalmology, the authors describe two patients with acute visual loss followed by optic disc atrophy initially labeled as atypical optic neuritis (ON). Though not suspected on clinical examination, optical coherence tomography (OCT) revealed deeply buried optic disc drusen (ODD) as a predisposing factor for-arteritic anterior ischemic optic neuropathy (NAION).

Case 1:
A 48-year-old woman had bilateral sequential visual loss associated with optic disc edema. Despite treatment, vision did not improve and severe disc pallor ensued. Atypical ON was suspected. Eventually, she was started on immunosuppressant therapy based on a tentative diagnosis of NMO-spectrum disorder.

On examination 5 years later, only severe optic disc pallor was observed, but OCT radial B-scans showed ovoid hyporeflective areas in the retrolaminar region of both eyes, compatible with ODD; this led to a diagnosis of NAION and deeply buried ODD.

Case 2.
A 35-year-old woman with suspicion of ON in the left eye and a history of previous atypical ON in the right eye was referred for neuro-ophthalmic examination which revealed diffuse optic disc pallor and a dense arcuate visual field defect in the right eye.

OCT B-scans passing through the disc showed large ovoid areas of reduced reflectivity in the retrolaminar region of the optic disc in the right eye. These findings helped confirm the diagnosis of NAION in one eye, with deeply buried ODD as predisposing factor.

Learning Points:-
• Deeply buried ODD may be associated with NAION causing irreversible visual loss and optic disc pallor, a condition easily mistaken for atypical ON.

• Awareness of such occurrence is important to avoid unnecessary testing and minimize the risk of mismanagement.

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