Visual field defects

Question 1

Visual field pathway

Answer 1

Visual field (L/R)
Retina (nasal/temporal)
Optic nerve
Optic chiasm
Optic tract
Lateral geniculate nucleus
Optic radiation (temporal/parietal lobe)
Occipital lobe

Question 2

Lesion at macular

Answer 2

Ipsilateral central scotoma

Question 3

Lesion at optic nerve

Answer 3

Ipsilateral monocular blindness

Question 4

Lesion at optic chiasm

Answer 4

Bitemporal hemianopia

Question 5

Lesion at optic tract

Answer 5

Contralateral homonymous hemianopia

Question 6

Lesion at temporal lobe

Answer 6

Contralateral superior quadrantanopia

Question 7

Lesion at parietal lobe

Answer 7

Contralateral inferior quadrantanopia

Question 8

Lesion at occipital lobe

Answer 8

Contralateral homonymous hemianopia with macular sparing
(If superior vision is more affected, lesion is located inferior to calcarine sulcus and vice versa)

Question 9

How to test for presence of macular sparing?

Answer 9

Move red target horizontally from non-seeing field into seeing field
If the red pin is noticed before it crosses the midline, macular sparing is present

Question 10

Types of monocular visual field defects

Answer 10

1. Central scotoma
2. Inferior altitudinal defect
3. Arcuate defect arising from blind spot

Question 11

Cause of central scotoma

Answer 11

Optic neuritis (affects macular)
ARMD
Maculopathy

Question 12

Cause of inferior altitudinal defect

Answer 12

Ischemic optic neuropathy

Question 13

Cause of arcuate defect arising from blind spot

Answer 13

Glaucoma

Question 14

Types of binocular visual field defects

Answer 14

1. Monocular visual loss in both e yes
2. Bitemporal hemianopia
3. Homonymous hemianopia
4. Homonymous superior quadrantanopia
5. Homonymous inferior quadrantanopia
6. Homonymous hemianopia with macular sparing

Question 15

Cause of monocular visual loss in both eyes

Answer 15

Bilateral optic neuropathies or retinopathies

Question 16

Cause of bitemporal hemianopia

Answer 16

Optic chiasm
- Pituitary macroadenoma
- Craniopharyngioma
- Meningioma

Question 17

Cause of homonymous hemianopia

Answer 17

Contralateral retrochiasmal visual pathway

Question 18

Cause of homonymous superior quadrantanopia

Answer 18

Contralateral temporal lobe

Question 19

Cause of homonymous inferior quadrantanopia

Answer 19

Contralateral parietal lobe

Question 20

Cause of homonymous hemianopia with macular sparing

Answer 20

PCA stroke (Occipital lobe)
- Macular sparing due to dual supply of blood to macula by PCA and MCA

Question 21

Symptoms of lesion at optic chiasm

Answer 21

Chiasmal syndrome
- Bitemporal hemianopia* (hallmark sx)
- Signs of raised ICP
- Headaches
- Acromegaly
- Galactorrhoea
- Gynaecomastia
- Visual hallucinations

Question 22

Signs of chiasmal compression seen on fundoscopy

Answer 22

Bowtie optic atrophy
Papilloedema = bilateral disc swelling
(think of raised ICP)

Question 23

Clinical testing of visual field

Answer 23

Central VF
1. Amsler chart
2. Confrontation
- Count fingers
- Hand movement
- Light projection

Peripheral VF
1. Confrontation
2. Red dot perimetry

Question 24

Investigations for VF

Answer 24

Bjerrum screen
Goldmann perimetry
Humphrey perimetry

Question 25

what type of nystagmus is associated with bitemporal hemianopia?

Answer 25

see-saw nystagmus