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
    • 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
    • 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

    Optic Nerve And Chiasm Disorders

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