The Optic Nerve
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.

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