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