Diabetic Papillopathy
- Acquired elevation of the optic disc in one eye or both eyes in patients with diabetes mellitus Type 1 or Type 2
- Pathogenesis is unknown, but may be mild, chronic, reversible optic disc ischemia
- Visual dysfunction is usually mild, causing confusion with papilledema, especially when both optic discs are affected
- Usually eventually resolves, but often endures for many months
- No effective treatment
- Patient is often visually asymptomatic
- Hyperemic swelling of one optic disc or both
- Visual acuity is often normal and visual fields show only mild nerve fiber bundle visual field loss
- Pupils are often normal, although an afferent pupil defect may rarely be present
- Diabetic retinopathy need not be present
- Orbit/brain MRI shows no contributory abnormalities
- Papilledema
- Non-arteritic ischemic optic neuropathy
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Tip: the “pre-eruptive” optic disc in non-arteritic ischemic optic neuropathy, when infarction has not yet occurred, looks chronically swollen, and is associated with normal visual function
- Typical optic neuritis
- Atypical optic neuritis
- Infiltrative optic neuropathy
- Hypertensive optic disc edema
- Chronic orbital compressive optic neuropathy
- Optic disc edema in POEMS syndrome, perhaps caused by increased vascular permeability from high levels of vascular endothelial growth factor (VEGF)
- Perform MRI
- If MRI is normal, lumbar puncture may be necessary to exclude increased intracranial pressure and chronic meningitis
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Trap: this condition is difficult to distinguish from papilledema, which is also binocularly symmetric and causes only mild visual dysfunction
- Optic fundus and visual field abnormalities remain stable for months and then spontaneously resolve