Neuroophthalmology: part 1, visual fields david.kinshuckgoodhope.nhs.uk

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Neuro-ophthalmology part 1, visual
fieldsdavid.kinshuck_at_goodhope.nhs.uk

• Visual field abnormalitiesprimarily those
  related to neuro-ophthalmic problems
• Case
• Field defect in relation to anatomical location
• Importance of the history and examination
• Quiz

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case

• A 43y woman complains of a mild headache (left
  forehead). The headache has been present 2
  months, and is not getting better.
• As you listen she tells you the sight is dim in
  left eye.
• Examination confirms red colours in the left eye
  are not as bright as when seen with the right
  eye.
• Further examination shows a pale optic disk and
  afferent pupillary defect, and visual field
  defect, but even without these findings a CT scan
  is needed. CT scan details

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case
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Recallvisual pathway
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Recalldisease of the eye itself causes various
visual symptoms
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Recalldisease of the eye itself causes various
visual symptoms
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Optic nerve
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Optic nerve
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Pituitary (chiasmal) area
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Pituitary (chiasmal) area
right
left
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Retrochisamal
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Retrochisamal
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Visual symptoms mini-quiz
old patient
Central vision reducedoptic nerve
Central vision reduced ARMD
Young patient
Superior retinal vein occlusion
Loss of colour visionoptic nerveunilateral
Tunnel visionyoung patientRP
This field both eyesCVA/SOL Temporal lobe
This field both eyesCVA/SOL
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Questions
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Summary

• The history can give you a BIG clue
• CT/MRI helpful but experts will locate lesion
  without
• Horizontal border to defects.eye
• Vertical..retro-chiasm
• Early diseasefew if any symptoms
• Small pituitary tumoursno field defect
  (microadenomas)
• Key symptoms can be very localising..eg loss of
  colour vision in one eye, gradual increase in
  headache over 2 months,