Visual Field Defects

Question 1

What are the main points to remember for the exam?

Answer 1

• Left homonymous hemianopia means visual field defect to the left, i.e. Lesion of right optic tract
• Homonymous quadrantanopias: PITS
  
  • ​Parietal-Inferior
  • Temporal-Superior
• Incongruous defects = optic tract lesion
• Congruous defects = optic radiation lesion or occipital cortex

A congruous defect simply means complete or symmetrical visual field loss

An incongruous defect visual field loss that is a different shape in each eye.

Question 2

Left homonymous hemianopia with incongruous defects.

Answer 2

Lesion of right optic tract

Incongruous defects are more likely to be in the optic tract.

Causes: Vascular disease, Head injury, Cerebral tumour.

After the optic chiasm (optic tract & optic radiations) visual field defects will be on the contralateral aspect of the brain.

Question 3

Right homonymous hemianopia with congruous defects.

Answer 3

Lesion of the left optic radiation

Causes: Stroke, Space Occupying lesions

Question 4

Right homonymous hemianopia with macula sparing (Central vision is spared)

Answer 4

Lesion of the left side of the occipital cortex

Causes: Posterior circulation stroke

Question 5

Bitemporal hemianopia

Answer 5

A lesion of the optic chiasm

Upper quadrant defects = inferior chiasmal compression = pituitary tumour.

Lower quadrant defects = superior chiasmal compression = Craniopharyngioma

Question 6

Superior Homonymous Quadrantanopias

(REMEMBER PITS)

Answer 6

Temporal lobe lesion

Question 7

Inferior Homonymous Quadrantanopias

(REMEMBER PITS)

Answer 7

Parietal lobe lesion.