Papillophlebitis Presenting As Optic Disc Edema Following Cervical Manipulation: A Case Report

Papillophlebitis is an uncommon inflammatory disorder of the retinal venous system that typically affects young adults but can also present in older individuals. We report the case of a 68-year-old woman who developed unilateral optic disc edema following cervical manipulation. The best-corrected visual acuity was 20/20 and 20/13 in the right and left eyes, respectively, with no relative afferent pupillary defect. Fluorescein angiography revealed disc leakage without capillary nonperfusion, and optical coherence tomography showed marked peripapillary retinal nerve fiber layer thickening without macular involvement. Brain and orbital magnetic resonance imaging revealed no abnormalities, including intracranial hypertension or venous sinus thrombosis. Based on the clinical and imaging findings, papillophlebitis was diagnosed, and oral corticosteroid therapy was initiated, resulting in the rapid resolution of disc edema and normalization of visual field findings within one month. This case highlights that a clinical picture highly suggestive of papillophlebitis can occur in older adults, potentially triggered by transient circulatory stress, and underscores the effectiveness of corticosteroid therapy in achieving complete anatomical and functional recovery of the optic nerve.