Abstract: SA-PO0387
Ocular Disequilibrium Syndrome: A Case Report of an Underestimated, Underdiagnosed, and Underreported Reality Among Patients on Hemodialysis
Session Information
- Home Dialysis: Science and Cases, from Lab to Living Room
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Soni, Ashesh, Orlando College of Osteopathic Medicine, Winter Garden, Florida, United States
- Franco Garcia, Alexandra, Orlando College of Osteopathic Medicine, Winter Garden, Florida, United States
- Moreno Castaneda, Carlos Hernando, AdventHealth Orlando, Orlando, Florida, United States
Introduction
Ocular Disequilibrium Syndrome (ODS) is a cluster of neurological and ocular symptoms that may occur during renal replacement therapy (RRT), often linked to poor compliance with hemodialysis. The syndrome results from imbalances in fluid volume, osmotic gradients, and urea levels in the plasma and cerebrospinal fluid, leading to elevations in both intracranial and intraocular pressures during or immediately following RRT. This case highlights the need for a preventive approach, as the patient was fully adherent to home dialysis yet did not improve with routine medical management.
Case Description
A 41-year-old male with ESRD on home hemodialysis, hypertension, type 2 diabetes, and glaucoma presented to the ED with severe left eye pain that began during a dialysis session one week prior. He was noncompliant with his dialysis regimen for over five days due to worsening pain, with laboratory findings consistent with uremia. Suspecting ODS, nephrology slowed dialysis using a smaller filter and reduced flow, but symptoms persisted within 10 minutes of each session. Ophthalmologic evaluation revealed macular edema, diabetic retinopathy, and neovascular glaucoma. Intraocular pressure (IOP) was 11 mmHg in the right eye and 36 mmHg in the left (reference range: 10–21 mmHg). The patient underwent urgent Ahmed® glaucoma valve placement, with full resolution of symptoms within 48 hours postoperatively.
Discussion
Ocular Disequilibrium Syndrome (ODS) is a conglomerate of symptoms that result from a rapid redistribution of urea and fluids between body compartments. Normally, urea is distributed evenly in plasma and tissues. In ESRD dialysis removes urea from plasma faster than from tissues, thus creating osmotic gradients that draw fluid into cells, leading to cerebral edema. In the case of ODS, similar shifts occur in the eye, rapidly increasing ocular pressure. These gradients are especially important in patients with impaired aqueous humor drainage, such as those with glaucoma. Symptoms may include vision changes, nausea, headaches, altered mental status, or seizures. In most cases, this phenomenon responds to a transition to slow dialysis, however as this case shows, some patients require surgical intervention when conservative approaches fail.