Visual Field Defects

Aetiology

• Vascular disease - CVA

• Space occupying lesion (SOL) e.g. pituitary tumour

• Demyelination (MS)

• Trauma - including surgical

Pathophysiology

1. Total left eye visual loss

2. Bitemporal hemianopia

3. Right homonymous hemianopia

4. Right homonymous upper quadrantanopia

5. Right homonymous hemianopia with macular sparing

Optic nerve defects

Causes

• Ischaemic optic neuropathy

• Optic neuritis - commonly MS

• Tumours (rare) - meningioma, glioma, haemangioma

Field defect

• Unilateral visual loss

Features of optic neuritis

• Progressive unilateral visual loss

• Pain behind eye, especially on movement

• Colour desaturation

• Central scotoma

• Gradual recovery over weeks to months

Complications - optic atrophy

• Optic atrophy: death of the retinal ganglion cell axons that comprise the optic nerve

• End stage that arises from damage to the optic nerve of any cause

• Results in a pale optic disc on fundoscopy

Optic chiasm defects

Causes

• Pitutary tumour - visual loss/distrubance commonly reversed after tumour decompressed/removed

• Craniopharyngioma

• Meningioma

Field defect

• Bitemporal field defect

Optic tracts and radiations

Causes

• Tumours (primary or secondary)

• Demyelination

• Vascular anomalies

Field defect

• Optic tract - contralateral homonymous hemianopia

• Optic radiation - contralateral homonymous quadrantanopia

• Macula not spared

Occipital cortex

Causes

• Vascular disease (CVA)

• Demyelination

Field defect

• Contralateral homonymous hemianopia with macular sparing