Visual field defects
Definition
Alteration in the visual
field, resulting in reduced
field in one or both eyes
Pathophysiology
Physiology
Optic nerve tract formed from temporal retina (medial view) and nasal retina (lateral view) from each eye
At optic chiasm, nasal tracts cross, so L temporal and R nasal to left hemisphere, R temporal and L nasal to right
So right side of vision controlled by L hemi and vice versa
Tract goes to lateral geniculate body then splits into superior and inferior radiations (lower and upper vision) then visual cortex)
Defect
Lesion can occur anywhere along the tracts
Monocular blindness
Bitemporal hemianopia
Homonymous hemianopia
Upper/lower L/R quadrantinopia
Cortical blindness
Aetiology
Optic chiasm
Vascular: large internal carotid artery aneurysm
Neoplastic: craniopharyngoma, meningioma, pituitary tumour
Optic tract
Vascular: stroke, haemorrhage
Autoimmune: MS
Neoplastic: CNS tumour
Optic nerve
Vascular: TIA
Infection: optic neuritis
Autoimmune: GCA
Diagnosis
Examination
Investigations
History
DH
Meds, allergies
FH
Visual disorder,
neurological disorder
PMH
Known medical conditions,
neurological disorder
SH
Living arrangements,
occupation, smoking, alcohol, drugs
PC/HPC
Visual change (SOCRATES),
pain, fever, weakness
CN exam
Reduced fields, any other pathology
CN limb exam
Any weakness etc.
Bloods
FBC, CRP/ESR, U+E, LFT,
clotting, bone profile
Imaging
CT/MRI head
Bedside
Obs
ECG
CSF
MCS, cytology
oligoclonal bands
Management
Initial ABCDE
Definitive
Per cause