Bilateral Posterior Ischemic Optic Neuropathy in a Patient with Severe Diabetic Ketoacidosis

PURPOSE: To report a case of bilateral posterior ischemic optic neuropathy (PION) in a patient with severe diabetic ketoacidosis (DKA). DESIGN: Observational case report. PARTICIPANT: A 35-year-old male who suffered bilateral visual loss during a severe episode of DKA. METHODS: Neuro-ophthalmological examination, neuroimaging consisting of a CT scan and MRI of the brain and orbits, as well as a MRA of brain vessels. RESULTS: Bilateral PION was diagnosed in a 35-year-old male with no light perception vision, who emerged from a coma caused by severe DKA. The patient developed optic nerve pallor in both eyes 4 weeks after the initial examination. Visual acuity with no light perception in both eyes remained unchanged after 6 months’ follow-up. CONCLUSIONS: Severe DKA can be complicated by bilateral PION, resulting in total blindness.