Ophthalmic Manifestations Heralding Renal Pathology: A Rare Case of Bilateral Optic Disc Edema with Exudative Maculopathy in IgA Nephropathy

IgA nephropathy (IgAN) (Berger's disease) is a primary glomerulonephritis characterized by mesangial deposition of IgA immune complexes. While it commonly presents with microscopic or gross hematuria, ocular findings as the initial manifestation are rare. Malignant hypertension, a severe complication of renal parenchymal disease, can lead to vision-threatening ocular changes such as optic disc edema, macular edema, and hypertensive choroidopathy. Early ophthalmic recognition can therefore play a pivotal role in uncovering the underlying systemic disorder.

A 19-year-old female presented with diminution of vision in both eyes, along with swelling and subconjunctival hemorrhage of the right eye for a period of 2 months. Ophthalmic examination revealed bilateral optic disc edema, macular edema, multiple dot-blot and flame-shaped hemorrhages, widespread soft exudates, and a temporal choroidal detachment in the right eye, suggestive of hypertensive retinopathy and choroidopathy. Systemic evaluation revealed severe hypertension (200/130 mm Hg) and laboratory findings of proteinuria, microscopic hematuria, and elevated serum creatinine. Renal biopsy confirmed IgAN with mesangial IgA deposition. The patient was started on antihypertensive and immunosuppressive therapy. On follow-up, the right eye developed a macular star pattern with visual improvement.

This case highlights a rare primary presentation of IgAN manifesting initially with ocular findings secondary to malignant hypertension. Fundus examination served as a critical diagnostic clue, leading to early identification of renal disease. Prompt multidisciplinary management is essential to prevent irreversible visual loss and systemic complications.