Unilateral nasal hemianopsia secondary to posterior subcapsular cataract

Glaucoma Mimickers: A major review of causes, diagnostic evaluation, and recommendations

Background: Glaucoma is characterized by chronic progressive optic neuropathy with corresponding visual field changes, with or without raised intraocular pressure (IOP). When diagnosing glaucoma or monitoring its progression, the examiner has to rely on the appearance of the optic disc, characteristic retinal nerve fiber layer defects, and corresponding visual field defects. However, similar changes and symptoms may be observed in several other disorders of the optic nerve and retina that may mimic glaucoma, often leading to misdiagnosis. Methods and result: The consequences of misdiagnosis not only result in improper treatment that may impact vision but also would negatively affect the overall health, psychological well-being of the patient, and may have considerable economic implications.Conclusion: The current review describes various conditions that mimic glaucoma and the features that help differentiate these conditions from glaucoma.

Binasal visual field defects caused by temporal posterior subcapsular cataracts

A 55-year-old female presented with binasal visual field defects and normal neuro-ophthalmic examination. Slit-lamp examination demonstrated posterior subcapsular cataracts that were located temporally in the visual axis. Due to the location of the nodal point in the eye, her visual field defect was contralateral to the opacity. Her visual field defects resolved after cataract surgery.

Acute monocular nasal hemianopia following a mild traumatic brain injury: A case report

INTRODUCTION

Monocular hemianopia is a visual field defect with an uncommon pattern. The etiology of monocular temporal hemianopia has been well-evaluated and has been suggested to result from an optic nerve or chiasmal lesion. However, the etiology of monocular nasal hemianopia remains unclear.

PATIENT CONCERNS

Here, we present the case of a 41-year-old male who was punched on the head with fists during a fight and then suffered from painless blurred vision in the left eye after mild traumatic brain injury. An ophthalmic examination revealed a conjunctival chemosis, periorbital hematoma, and a relative afferent pupillary defect in the left eye. Automated perimetry indicated there was a left side nasal hemianopia along the vertical meridian.

DIAGNOSIS

Examination of the fundus showed there was a normal appearing retina and disc bilaterally. Fluorescein angiography revealed no delayed filling of the vessels. Computed tomography and magnetic resonance imaging showed unremarkable findings of the visual pathways, orbit, and brain. A diagnosis of left traumatic optic neuropathy was made.

INTERVENTIONS

Systemic steroid pulse therapy (1 gram of intravenous methylprednisolone per day) was given to the patient for 3 days.

OUTCOMES

An ophthalmologic examination after treatment indicated there was no obvious improvement in the relative afferent pupillary defect, best corrected visual acuity, and color sense. A second set of automated perimetry results showedno changes after 3 months.

CONCLUSION

Monocular nasal hemianopia caused by traumatic optic neuropathy is uncommon. In this case, monocular nasal hemianopia was likely due to ischemic changes from impairment of the prechiasmal arterial anastomotic network or indirect injury to the lateral prechiasmal nerve fiber.

Monocular hemianopia secondary to stroke

Purpose

As a general rule, homonymous hemianopic defects localize to the retrochiasmal visual pathway and a monocular defect localizes at or anterior to the chiasm. We report three patients with a monocular hemianopia on automated static perimetry following cerebral stroke.

Observations

In this retrospective, consecutive case series, the charts of individuals presenting with stroke and monocular hemianopia were reviewed. Three individuals suffered cerebral stroke. Automated, static perimetry revealed a normal visual field in one eye and a monocular hemianopia in the other eye. No other neurologic, orbital or ocular causes were found.

Conclusions and Importance

To our knowledge, this is the first report of this pattern of visual field loss following stroke, and we hypothesize that this phenomenon may be a unique feature of automated perimetry. Magnetic resonance imaging of the brain could be considered in patients with a monocular hemianopia on static perimetry.

Monocular nasal hemianopia from atypical sphenoid wing meningioma

Neurogenic monocular nasal field defects respecting the vertical midline are quite uncommon. We report a case of a unilateral nasal hemianopia that was caused by compression of the left optic nerve by a sphenoid wing meningioma. Histological examination revealed that the pathology of the meningioma was consistent with that of an atypical meningioma, which carries a guarded prognosis with increased chance of recurrence. The tumor was debulked surgically, and the patient's visual field defect improved.