A 52 years old one eyed male presented with history of blurring of in right eye since 7 days which was rapidly progressing in onset and painless. Dilated fundoscopic examination of right eye showed pallid disc edema, venous dilation and a flame shaped superficial retinal hemorrhage in the peripapillary area with inferior altitudinal defect. Left eye was pthysical with no PL. On investigation patient was diagnosed to have diabetes mellitus with morbidly deranged metabolic status. This case was posed a diagnostic challenge as the clinical picture did not typically fit into the diagnosis of optic neuritis as the color vision was normal, RAPD could not be confirmed, disc showed pallid edema: AION was a differential diagnosis because of pallid edemaor the disc, peripapillary hemorrhage & altitudinal defect. The discovery of Diabetes mellitus on routine blood sugar estimation added Diabetic papillopathy to the list of differential diagnoses. However, it was the rapid therapeutic response with oral anti hypoglycemic agents in the form of improved vision & fileds that led to the incidental diagnosis of Diabetic papillopathy.

Keywords: Altitudinal defect; Anterior ischemic optic neuropathy Diabetic Papillopathy; Pallid edema, Pthysis, RAPD.