Drusen
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Drusen (singular, "druse") are tiny yellow or white accumulations of extracellular material that build up in Bruch's membrane of the eye. The presence of a few small ("hard") drusen is normal with advancing age, and most people over 40 have some hard drusen. However, the presence of larger and more numerous drusen in the macula is a common early sign of age-related macular degeneration (ARMD).
Drusen associated with aging and macular degeneration are distinct from another clinical entity, optic disc drusen, which is present on the optic nerve head[1]. Both age-related drusen and optic disc drusen can be observed by ophthalmoscopy.
Whether drusen promote ARMD or are symptomatic of an underlying process that causes both drusen and ARMD is not known, but they are indicators of increased risk of the complications of ARMD.[1]
Drusen were initially described by Donders [1] who named them for the German word for geode, based on their glittering appearance. In view of their location between the retinal pigment epithelium (RPE) and its vascular supply, the choriocapillaris, it is possible that drusen deprive the RPE and photoreceptors of oxygen and nutrients. Interestingly, drusen always develop above the so called pillars of choriocapillaris that is the area between two microvessels [1].
The source of the proteins and lipids in drusen is also not clear, with potential contributions by both the RPE and the choroid. Several trace elements are present in drusen [1] probably the most concentrated being zinc [1]. The protein composition of drusen includes apolipoproteins and members of the complement system. Zinc in drusen have been suggested to play a role in drusen formation by precipitating and inhibiting the elements of the complement cascade, especially complement factor H[1]. The presence of molecules that regulate inflammation in drusen has led some investigators to conclude that these deposits are product of the immune system. [1]
Diagnosis
Physical Examination
Eyes
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
