Ocular problems in the patient with end-stage renal disease

The patient with end-stage renal disease (ESRD) is at risk for development of eye disease. This risk is related to the comorbid conditions that are often seen in ESRD patients as well as to the unique effects of hemodialysis and the uremic state in leading to changes in the conjunctivae, cornea, retina, and macula. The most common ocular complaints in ESRD patients include red, irritated eyes, and may be associated with elevations in the calcium-phosphate product. In those patients with chronically elevated calcium-phosphate products, band keratopathy may result. Other eye conditions include macular edema, ischemic optic neuropathy, elevated intraocular pressure, retinal detachment, and retinal hemorrhage. Prompt recognition of these conditions that may threaten a patient's vision is required. This may prove challenging to the nephrologist in the dialysis unit where a detailed ophthalmological examination is difficult. However, a basic knowledge of the common ocular diseases encountered in the dialysis patient forms a framework for deciding which patients require urgent consultation with an ophthalmologist.