BACKGROUND: Vision loss resulting from thiamine deficiency is a recognized 
complication of bariatric surgery. Most patients with such vision loss have 
Wernicke encephalopathy with characteristic changes seen on neuroimaging. Other 
patients may have retinal hemorrhages, optic disc edema, and peripheral 
neuropathy without Wernicke encephalopathy. The risk for thiamine deficiency is 
potentiated by the presence of prolonged vomiting.
CASE REPORT: A 37-year-old female presented with abrupt onset of vision loss and 
peripheral neuropathy following bariatric surgery. She had a history of 
prolonged vomiting postoperatively. Examination of the posterior segment of the 
eye revealed optic disc edema and large retinal hemorrhages bilaterally. 
Metabolic workup demonstrated thiamine deficiency. She responded quickly to 
parenteral thiamine therapy with recovery of normal vision and resolution of 
ophthalmologic findings.
CONCLUSION: Patients who undergo bariatric surgery and have a thiamine 
deficiency can present with visual symptoms and ophthalmologic findings only 
visible by fundoscopy prior to developing more severe and potentially 
irreversible complications from the vitamin deficiency. Early detection of 
intraocular changes resulting from thiamine deficiency and initiation of therapy 
could prevent more devastating neurologic manifestations. Our case supports the 
consideration of a prospective study aimed at determining the true incidence of 
ocular and visual changes such as retinal hemorrhage, optic disc edema, and 
peripapillary telangiectasia in patients following bariatric surgery.