Hypotensive ischemic optic neuropathy and peritoneal dialysis.
OBJECTIVE
To report anterior ischemic optic neuropathy associated with systemic hypotension in a patient undergoing continuous ambulatory peritoneal dialysis.


METHODS
Case report. A 58-year-old man undergoing continuous ambulatory peritoneal dialysis developed painless blurred vision in both eyes and bilateral optic disk swelling with an altitudinal field defect in the left eye. Twenty-four-hour ambulatory blood pressure monitoring was requested in addition to other routine investigations.


RESULTS
Routine blood pressure measurement in the clinic was 130/86 mm Hg, but ambulatory blood pressure monitoring demonstrated pronounced early morning hypotension with individual readings as low as 91/41 mm Hg.


CONCLUSIONS
Renal dialysis can render patients hypotensive, and this may be associated with anterior ischemic optic neuropathy. The overnight drop in blood pressure may not be appreciated with routine blood pressure measurement. Therefore, 24-hour ambulatory blood pressure monitoring should be considered when investigating patients with suspected anterior ischemic optic neuropathy who are undergoing renal replacement.
Jackson
T L
TL
The Sussex Eye Hospital, Brighton, United Kingdom. tjackson@r2d2c3po.freeserve.co.uk
Farmer
C K
CK
Kingswood
C
C
Vickers
S
S
D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D005654:Fundus Oculi; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology*; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009397:Nephrocalcinosis / Q000628:therapy; D018917:Optic Neuropathy, Ischemic / Q000175:diagnosis / Q000209:etiology*; D010211:Papilledema / Q000209:etiology; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity