Optic Neuritis in Patients with Type 2 Diabetes Mellitus: A Case Series

Abstract

Diabetes mellitus is a group of metabolic disorders characterised by a high blood sugar level over a prolonged period of time. Ocular associations of diabetes include diabetic retinopathy, cataract, diabetic papillopathy, ocular movement disorders and optic neuritis. Optic neuritis is a clinical condition causing inflammation of the myelin sheet of optic nerve. This leads to alteration in the nerve conduction towards the brain. Diabetics are more commonly affected with anterior ischaemic optic neuropathy compared to papillitis or optic neuritis. The present case series is of diabetes associated papillitis. The patients were in the age range of 35-60 years. All the patients had poor visual acuity at presentation, mild disc oedema and disc elevation with no peripapillary haemorrhage, suggestive of papillitis. The patients had minimum background retinopathy and were hyperglycaemic at the time of presentation. The response to Intravenous (IV) methyl prednisolone, at a dose of 1 gm IV in 100 mL of normal saline, was good. Improvement to vision was seen within 3-5 days and improvement in colour vision was seen at the end of 11-15 days. Papillitis can be a manifestation of diabetes and should be kept as a differential diagnosis to non-arteritic ishaemic optic neuropathy. Optic neuropathies and background retinopathy may not co-exist. Poor systemic control of glycaemic level may directly co-relate to papillitis manifestation.