Diabetic papillopathy: The disc edema dilemma

Diabetic papillopathy (DP) is an uncommon condition characterized by transient visual dysfunction and is associated with unilateral or bilateral hyperemic optic disc swelling. The etiology of DP is unknown, but many authorities attribute diabetic microvasculature disease as a predisposing component. Associated risk factors include duration of diabetes, a small cup-to-disc ratio, and fluctuations of blood glucose. Patients often present with acute, unilateral, painless loss of vision that can vary in severity due to the confounding maculopathy which is sometimes present. Other common observations include telangiectasia of the disc, non-proliferative diabetic retinopathy, macular edema, and capillary non-perfusion. The optic nerve swelling typically resolves within a few months, with mild to no residual optic atrophy. The prognosis is relatively good despite the lack of definitive treatment; however, periocular and intravitreal corticosteroids may shorten the duration of DP and may provide a subjective improvement in vision. The diagnosis of DP can be challenging, as unilateral, sudden, painless loss of vision with a swollen nerve can have several etiologies, especially in a vasculopathic patient. This report depicts a middle aged, diabetic patient who experienced a sudden painless loss of vision and how the diagnosis of DP was determined.