How to Distinguish Pseudopapilledema from Papilledema

The differentiation of optic disc drusen (ODD) from true optic disc edema (ODE) is of critical importance, because ODE may represent a life-threatening condition requiring urgent and costly ancillary testing, whereas ODD is most often a benign process requiring only observation. In cases of ODD located on the disc surface, diagnosis may be straightforward, but with intrapapillary ODD ("buried drusen"), the optic disc appearance may mimic that of ODE. Ancillary testing has been utilized to aid in identification of ODD, including B-mode ultrasonography1, CT imaging, and fluorescein angiographic "autofluorescence." 2-5 Recently, specific fluorescein angiography (FA) criteria for differentiating ODD from ODE have been published6. Optical coherence tomography (OCT) is also evolving as a modality for differentiation of ODD from ODE.