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This presentation exhibits a case report and review of multiple reported cases of hyperemic optic disc swelling in patients with diabetes. After excluding all other known causes of optic nerve insult, this pathology has typically been labeled as diabetic papillopathy.We offer a case of a 65-year-old veteran with unilateral hyperemic optic disc swelling, presenting with minimal optic nerve dysfunction. After an extensive evaluation to rule out other causative pathology, this patient was diagnosed with diabetic papillopathy.Presented are clinical data of a case of diabetic papillopathy and a literature review to delineate the typical published clinical characteristics and course of this disease process. We also review literature to summarize the typical characteristics of anterior ischemic optic neuropathy and offer a hypothesis to reconcile the dilemmas regarding its relation to diabetic papillopathy.