Reversible bilateral optic disc swelling in a renal patient treated with nitrofurantoin

There are many causes of optic disc swelling in patients with chronic renal impairment. Broadly these fall into two groups. In the first group, optic nerve function is impaired from the onset of disease. These are usually (but not always) uniocular. These optic neuropathies are caused by the same underlying disease responsible for the renal impairment (vascular disease, vasculitis or more rarely a neoplastic process) or as a result of the renal impairment. In the second group, nerve function may be preserved in the early stages of the disease. This includes raised intracranial pressure and hypertensive optic neuropathy. Typically bilateral optic disc swelling occurs in this group. In our case the investigation and management was complicated by the patients’ multiple co-morbidities.