Optic disc swelling in young diabetic patients: a diagnostic dilemma

We describe four young diabetic patients presenting with swelling of one or both optica discs ('papiloedema'). Two were asymptomatic while the others complained of blurred vision. Spontaneous resolution occurred in all within 6 months although three had developed optic atrophy within 5 years. These four patients fit into a spectrum of acute involvement of the optic nerve in young diabetic patients, of which over 50 cases have now been reported. Most have florid ophthalmoscopic appearances which resolve within weeks or months and usually carry a good visual prognosis. The condition appears to be a variant of anterior ischaemic optic neuropathy though its possible pathophysiology in diabetes is uncertain. Knowledge of the condition by diabetologists and ophthalmologists is important as patients and doctors may be reassured after fairly simple investigation.