Neuro-Ophthalmology

Diabetic Papillopathy

Clinical Features

  • Atypical form of nonarteritic anterior ischemic optic neuropathy (NAION).
  • Symptoms include:
    • No visual symptom
    • Non-specific minimal visual disturbance such as painless mild blurring or distortion
    • Visual acuity is usually normal or mildly diminished, except coexisting diabetic maculopathy occurs
  • Optic nerve appearance:
    • Non-specific hyperemic disc swelling or a prominent dilated vessels mimicking neovascularization on the disc surface
    • In the setting of bilateral disc swelling, it is important to distinguish this finding from papilledema, therefore neuroimaging and if needed lumbar puncture to rule out increased ICP can be performed
    • Visual fields test may show enlarged blind spot with occasional arcuate or central field defect.
    • Disc edema may be bilateral.
    • The optic disc swelling usually resolves within 2-10 months with residual mild optic atrophy
  • Long-term visual prognosis depends on the presence of diabetic retinopathy and, very rarely, the progression of this papillopathy to anterior ischemic optic neuropathy.