Uremic optic neuropathy – review

Chronic kidney disease, dialysis and medical therapy can cause ocular disorders, affecting both the anterior and posterior segment of the eye, including the conjunctiva, cornea, lens, peripheral retina, macula and optic nerve. Uremic optic neuropathy, manifesting as sudden painless, progressive loss of vision and optic disc edema, is a very rare complication of end-stage chronic kidney disease, which may also be its first symptom. There are only a few reported cases in the world. Accurate diagnosis is important as initiating causal treatment (i.e. dialysis) and steroid therapy results in a significant or even spectacular improvement of visual acuity and resolution of visual field defects. When consulting cases of vision impairment and optic disc edema in patients with kidney disease, uremic neuropathy should be included in differential diagnosis, especially that there is no effective treatment for non-arteritic anterior ischemic optic neuropathy and the prognosis for visual recovery is unfavorable. Therefore, blood urea nitrogen and creatinine assays should become a diagnostic standard for any sudden vision loss.