scholarly journals Differential Diagnoses in Diabetic Optic Neuropathies: Diabetic Papillopathy, Ischemic Optic Neuropathy, and Optic Atrophy

2018 ◽  
pp. 124-129
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
Optic Atrophy ◽  
Chronic Phase ◽  
Ischemic Optic Neuropathy ◽  
Therapeutic Approaches ◽  
Vascular Effects ◽  
Optic Nerve Diseases

The devastating blinding effects of diabetic retinopathy are well documented. Although individually less common, diabetes mellitus (DM) may cause optic nerve complications. The vascular effects of DM seem to contribute to non-arteritic ischemic optic neuropathy and diabetic papillopathy. The finding of optic atrophy is non-specific and might represent the chronic phase of any optic neuropathy. This review presents an overview of the current diagnostic and therapeutic approaches, as well as the clinical features, of these optic nerve diseases, with consideration given to the presence of DM.

Acquired Optic Nerve Diseases

Visual Fields ◽  
2010 ◽  
Author(s):  
Peter A. Quiros ◽  
Alfredo A. Sadun
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Optic Nerve ◽  
Visual Field ◽  
Optic Neuritis ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Mass Effect ◽  
Ischemic Optic Neuropathy ◽  
Optic Nerve Diseases

This chapter focuses on the most frequently acquired optic nerve diseases: their signs and symptoms, visual field findings, and the required basic workup and management. Acquired optic nerve diseases are often vision threatening and sometimes even life threatening. There is a need for accurate and timely diagnosis. Therefore, it is incumbent on the clinician to identify optic neuropathies, separate them from chronic congenital and hereditary problems, and aggressively pursue the diagnosis and treatment as necessary. In the workup of optic neuropathies, the visual field is extremely helpful. All patients with suspected optic neuropathies require careful examination of the visual fields for detection, characterization, and monitoring. Acquired optic neuropathies include inflammatory, ischemic, compressive, metabolic, and central nervous system–reflected pathology (papilledema). Inflammatory optic neuropathies include optic neuritis and its various etiologies such as demyelination, infective, immune-mediated (atypical), and slowly progressive/ chronic. Ischemic optic neuropathies include nonarteritic ischemic optic neuropathy (NAION) and arteritic ischemic optic neuropathy (AAION). Metabolic optic neuropathies include nutritional and/or toxic etiologies. Compressive optic neuropathies can occur due to mass effect on the disc optic, gliomas, and perioptic meningiomas. Papilledema may be primary (pseudotumor cerebri) or secondary to central nervous system mass effect. Optic neuritis is defined as a primary inflammation of the optic nerve. It is characterized by central visual loss that worsens over days and usually peaks about 1 to 2 weeks after the onset. It is usually unilateral but may be bilateral, especially in children, following viral infections like measles, mumps, and chickenpox. It occurs most commonly in adults (18-45 years old). Orbital or periocular pain may be present or precede the visual loss and is exacerbated with eye movements. Etiologies include demyelinating diseases/multiple sclerosis;, idiopathic, viral, or bacterial infections (syphilis); contiguous inflammation of the meninges, orbit, or sinuses,; granulomatous inflammation (tuberculosis, sarcoidosis, and cryptococosis); and autoimmune diseases. It is the most common cause of acute visual loss from optic nerve disease in the young and middle-aged adult group.

Bilateral diabetic papillopathy developed after starting insulin treatment. Potential toxic effect of insulin? A case report

2020 ◽  
pp. 112067212098438
Author(s):  
Marco Mafrici ◽  
Laura Toscani ◽  
Umberto Lorenzi
Keyword(s):  
Diabetic Retinopathy ◽  
Optic Nerve ◽  
Insulin Therapy ◽  
Rare Case ◽  
Insulin Treatment ◽  
Brain Magnetic Resonance Imaging ◽  
Diabetic Patients ◽  
Ischemic Optic Neuropathy ◽  
History Of ◽  
Hypoglycemic Therapy

Background: Diabetic papillopathy is a complication of diabetes. It presents with edema, uni or bilateral and vascular alteration of the anterior optic nerve. Often this complication is observed in patients with severe diabetic retinopathy, but is rarely observed in isolated form. Some authors believe that diabetic papillitis is a particular form of non-arteritic anterior ischemic optic neuropathy (NAION). But there is important evidence that confers an inflammatory component to diabetic papillopathy. We report in this work a rare case of isolated acute bilateral diabetic papillopathy developed in a diabetic patient after adding the insulin to the oral hypoglycemic therapy. Case presentation: Male patient, 49-years-old, diabetic type 2, with altered glycemia at follow up, with clinical history of HbA1c 8% to 12% in the last 2 years, on oral hypoglycemic therapy for 10 years. He never had a history of diabetic retinopathy. At the last check-up, this patient presented bilateral papillopathy, without reduction of visual acuity bilaterally. The patient reports he added 10 days before the insulin therapy to the oral hypoglycemic therapy, under medical supervision. Hematochemical and serological tests were requested, which excluded the presence of inflammatory and infectious diseases. The brain magnetic resonance imaging (MRI) with gadolinium excluded the hypothesis of optic neuritis or intracranial hypertension. Cardio-circulatory tests were normal. Fluorescein angiographic examinations and optical coherence tomography (oct) confirmed the bilateral edema and the thickening of optic nerve without other retinal damage. Therefore he was diagnosed with bilateral diabetic papillopathy. Then, diabetologists added pump insulin treatment to the oral hypoglycemic therapy. After 2 months, his blood sugar levels and HbA1C improved and papillopathy regressed. Conclusion: We have reported a rare case of bilateral acute diabetic papillopathy associated with the addition of insulin to the oral hypoglycemic therapy. A randomized control study with diabetic patients, would be useful to verify the possible injuries of the optic nerves during the delicate transition to insulin therapy.

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