Bilateral Disc Swelling in Renal Failure; Hypertensive Optic Neuropathy or Papilloedema?

Both hypertensive optic neuropathy and papilloedema present with bilateral disc swelling, normal visual acuity and colour vision in the acute stage. We present a patient with chronic renal failure, elevated blood pressure and bilateral disc swelling. Although initially diagnosed with malignant hypertension and hypertensive optic neuropathy, neuro-ophthalmological evaluation indicated papilloedema and lumbar puncture confirmed idiopathic intracranial hypertension (IIH). We will show photos to differentiate the clinical features of these two life- and sight-threatening conditions. We also review literature on the etiology of disc swelling in patients with renal failure and postulate on the mechanism of IIH in patients with renal failure.