1. Neuro-ophthalmology: part 1, visual fields david. kinshuck@goodhope
Neuro-ophthalmology: part 1, visual fields
Visual field abnormalities…primarily those related to neuro-ophthalmic problems
Case
Field defect in relation to anatomical location
Importance of the history and examination
Quiz
08/12/2018

2. As you listen she tells you the sight is dim in left eye.
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:
08/12/2018

3. case
08/12/2018

4. Recall …visual pathway
08/12/2018

5. Recall …disease of the eye itself causes various visual symptoms
08/12/2018

6. Recall …disease of the eye itself causes various visual symptoms
Retinal vascular occlusion
cataract
Macular degeneration
glaucoma
Refractive error
Retinitis pigmentosa or advanced glaucoma
08/12/2018

7. Optic nerve
08/12/2018

8. Pain behind eye with eye movements + visual symptoms
Optic nerve
No symptoms
Loss of colour vision
Central scotoma
(or greater)
Pain behind eye with eye movements + visual symptoms
Headache and visual symptoms
08/12/2018

9. Pituitary (chiasmal) area
08/12/2018

10. Pituitary (chiasmal) area
right
left
08/12/2018

11. Retrochisamal
08/12/2018

12. Smaller lesions…specificfeatures…this is temporal lobe
Retrochisamal
Smaller lesions…specificfeatures…this is temporal lobe
Large lesion anywhere
08/12/2018

13. Visual symptoms mini-quiz
old patient
Central vision reduced optic nerve
Central vision reduced ARMD
Young patient
Superior retinal vein occlusion
Loss of colour vision…optic nerve unilateral
Tunnel vision…young patient…RP
This field both eyes…CVA/SOL
Temporal lobe
This field both eyes…CVA/SOL
08/12/2018

14. Questions
08/12/2018

15. The history can give you a BIG clue
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 disease…few if any symptoms
Small pituitary tumours…no field defect (microadenomas)
Key symptoms can be very localising..eg loss of colour vision in one eye, gradual increase in headache over 2 months,
08/12/2018