Bilateral optic disc edema in patients with severe systemic arterial hypertension: clinical features and visual...

To report clinical features and visual outcomes in patients with bilateral optic disc edema and severe systemic arterial hypertension.

Records were reviewed of patients with bilateral optic disc edema, severe arterial hypertension, and 3 or more months of follow-up evaluated at Bascom Palmer Eye Institute between 1982 and 2003.

Sixteen patients (median age = 41 years; median follow-up = 31 months) were identified. Median blood pressure on initial eye examination was 220 mm Hg systolic and 126 mm Hg diastolic. Among all study eyes, median visual acuity was 20/55 on presentation. At the last follow-up examination, an acuity of 20/50 or better was achieved in 20 (63%) eyes; 12 (75%) patients achieved a final acuity of 20/50 or better in at least one eye. Posterior segment abnormalities at last follow-up included disc pallor (n = 16), macular star (n = 7), retinal pigment epithelial atrophy (n = 7), epiretinal membrane (n = 5), branch retinal vein occlusion (n = 4), and persistent disc edema (n = 2). Causes of final acuity of less than 20/50 included optic atrophy, epiretinal membrane, serous retinal detachment, macular hole, and branch retinal vein occlusion.

Most patients with bilateral optic disc edema and severe arterial hypertension maintained visual acuity of 20/50 or better in at least one eye.