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End-stage renal disease (ESRD) is associated with a number of serious complications, including increased cardiovascular disease, anaemia and metabolic bone disease. Optic atrophy secondary to chronic anaemia in ESRD is rare. We report a case of bilateral optic atrophy in a young patient with chronic anaemia secondary to ESRD. A 23-year-old lady with ESRD, presented with progressive blurring of vision in her left eye for a period of six months. Visual acuity in the left eye was counting finger and the right eye was 6/6. Left optic nerve