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Diabetic papillopathy

Madhura Tamhankar, MD
Nicholas J Volpe, MD
Section Editor
Paul W Brazis, MD
Deputy Editor
Janet L Wilterdink, MD


Diabetic papillopathy (DP) is a term that is used to characterize a finding of unilateral or bilateral optic disc edema with variable visual loss seen in patients with diabetes. It can occur in patients with type 1 diabetes mellitus (DM) and type 2 DM irrespective of metabolic control or severity of diabetic retinopathy.  

Specific criteria for the diagnosis of diabetic papillopathy and a clear differentiation of this entity from nonarteritic anterior ischemic optic neuropathy (NAION) have not been established [1]. While diabetic papillopathy has a generally favorable prognosis and does not usually require treatment, it must be distinguished from more malignant processes such as papilledema, other infectious and inflammatory causes causing bilateral disc swelling, and those causing increased intracranial pressure.

This topic discusses diabetic papillopathy. NAION and other conditions causing optic disc swelling are discussed separately. (See "Nonarteritic anterior ischemic optic neuropathy: Epidemiology, pathogenesis, and etiologies" and "Nonarteritic anterior ischemic optic neuropathy: Clinical features and diagnosis" and "Nonarteritic ischemic optic neuropathy: Prognosis and treatment" and "Overview and differential diagnosis of papilledema".)


Diabetic papillopathy is rare with an estimated incidence of 0.5 percent [2]. Initially described in younger patients with type 1 diabetes [3-7], subsequent publications have reported that DP also occurs in older individuals (up to 79 years old) with type 2 diabetes [8-10].


The pathogenesis of DP is uncertain. A diabetic microangiopathy has been proposed as an etiology, but no pathologic studies of DP have been reported to confirm or refute this theory. There is no clear association between DP and the state of metabolic control of the diabetes or with the stage of diabetic retinopathy [5,9]. Most reported cases of DP occur in patients with long-standing diabetes, but duration of diabetes is not proven to be a risk factor for DP [4,5,7,9].

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Literature review current through: Nov 2017. | This topic last updated: Jun 26, 2016.
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