Visual loss in uremic patients on dialysis: a case report and review of literature

We report a 40-year-old female patient who was on maintenance hemodialysis for end-stage renal disease. She was initially noted to have severe hypertension necessitating use of four anti-hypertensive drugs. Gradually, and with regular dialysis, her blood pressure normalized without any medications, and subsequently she was noted to have pre- and post-dialysis blood pressure respectively of 90/60 mm Hg and 70/40 mm Hg which was asymptomatic. Following one session of dialysis during which she had severe hypotension associated with dizziness and headache, corrected by saline infusion, she noticed loss of vision affecting both eyes. Detailed evaluation including fundoscopy, magnetic resonance imaging, fluorescein angiography, color doppler and electroretinogram was performed. Empirical treatment with pulse methyl prednisolone and plasma exchange did not help. A diagnosis of anterior ischemia optic neuropathy due to hypotension was arrived at. Our case suggests that intra-dialytic hypotension can be problematic and should be treated aggressively.