Papillophlebitis: A case series of a controversial diagnosis

Abstract

Aims/Purpose: Papillophlebitis refers to an isolated optic disc oedema with venous engorgement in asymptomatic patients as defined by Walsh and Hoyt in 1969. We report a case series of 3 patients who developed papillophlebitis related to SARS‐CoV‐2 vaccination, type 2 diabetes or idiopathic. A literature review was also performed.Methods: Observational case report of 3 patients and a review of the literature covering papillophlebitis cases was performed using Pubmed, Embase and Web of Science. Cases presenting with visual loss, RAPD, visual field defect or retinal vascular occlusion were excluded.Results: We report the case of 3 patients who did not have any visual complain and presented a unilateral optic disc oedema found by chance. The 1st patient was 33 year‐old and her past medical history was significant for SARS‐Cov‐2 vaccination. The 2nd patient was 6 year‐old and in general good health. The 3rd patient was known for a type 2 diabetes with no complications. For all patients, the visual acuity was 1.0, the intraocular pressure was normal, the anterior segment was quiet and the fundus showed a unilateral optic disc oedema without any haemorrhage. The RNFL OCT confirmed the presence of an optic disc oedema. The visual field was normal. An extensive blood test was negative for auto‐immune, inflammatory and vascular disease. In our patients, the optic disc oedema decreased spontaneously after a couple of months without any treatment and they retain 1.0 vision. A diagnosis of papillophlebitis was made. In the literature, the term papillophlebitis is not well‐defined and controversial. No treatment is required, and the condition resolved spontaneously over time. The visual prognosis is excellent as patients keep a 1.0 vision with a normal visual function. No recurrence has been reported.Conclusions: Papillophlebitis is diagnosed after ruling out any inflammatory, infectious or auto‐immune disease in asymptomatic patients who present a spontaneous recovery without any treatment as reported in our cases.