Neuro-ophthalmology: Diabetic Papillopathy

Question 1

Describe diabetic papillopathy?

Answer 1

• Optic disc swelling in diabetic px
• Diagnostic & therapeutic challenge
• Rare
• Pathogenesis unclear:
  o May be caused by capillary damage – damage to smaller capillaries due to diabetes
• Association w/ small cup/disc ratio & rapid reduction in glycemia
• Vascular leakage & oedema of nerve fibres
• Chronic ischaemia & secondary nerve swelling
  Does not result in full blown ischaemic optic neuropathy
  Usually diagnosed on examination rather than on symptoms

Question 2

What are the symptoms of diabetic papillopathy?

Answer 2

• Usually asymptomatic or w/ mild symptoms

Question 3

What are the signs of diabetic papillopathy?

Answer 3

• Unilateral
• VA 6/12 or better
• Mild or no RAPD
• Visual Field:
  o Enlargement of blind spot
  o Constriction in VF or altitudinal loss in severe cases
• Frequently found on fundus examination
• Fundus Examination:
  o Mild disc oedema w/ hyperaemia
  o Telangiectasis (spider-like dilated capillaries) which could be confused w/ neovascularisation (new BVs)

Question 4

What is the management of diabetic papillopathy?

Answer 4

• In community, difficult to differentiate from other causes of swollen disc
• Emergency referral to ophthalmology
• Little evidence that tx is successful
• Possibly corticosteroids/steroids

Question 5

What is the prognosis of diabetic papillopathy?

Answer 5

• Visual prognosis good: 6/12 or better
• May take 6 months or longer for oedema to resolve
• 5 to 15% progress to non-arteritic ischaemic optic neuropathy
  o Warn px that it may recur & seek attention ASAP