Case Closed Friday: Eye Have a Problem

Earlier this week, we gave you a hypothetical patient with the following case:

This week, our hypothetical patient is a 65-year-old woman experiencing decreased bilateral vision over the past month. She was told by her doctors that this was secondary to early age-related macular degeneration. She reports difficulty reading, loss of depth perception, and dimness of her vision in addition to having dull headaches that began about 6 months ago. She did not have any ocular pain or new flashes, floaters, or diplopia. The patient denied the use of tobacco or alcohol and did not have any family history of ocular issues. She is currently being treated with Seroquel for her bipolar disorder. Upon examination the patient demonstrated an inability to see anything in the outer half of both her left and right visual fields. Slit lamp biomicroscopy demonstrated that the macular and retinal nerve fiber layer OCT were normal in both eyes. A Humphrey visual field (HVF) 30-2 was performed.

Today, we reveal that our hypothetical patient was diagnosed as having: 

Bitemporal Hemianopsia

This could have been confirmed by the results of the HVF test. This condition is characterized by the loss of vision in the temporal visual field and is often due to compression of the nasal fibers on the optic chiasm. (Remember that the fibers of the optic chiasm cross one another, thus pressure on the nasal fibers of the chiasm affects the temporal visual field or peripheral vision.) There are many things that can cause this compression, but it most often results from intracranial tumors. It can also be caused by demyelinating diseases, inflammatory diseases, or ocular aneurysms. MRIs can help to reveal these underlying causes. Courses of treatment begin with identifying the underlying cause of the bitemporal hemianopsia. Depending upon the cause, a patient may undergo hemianopsia rehabilitation, such as training the eyes to search into the area of field that is missing, patching one eye, adding a stereo-typoscope device, or surgical interventions to deal with tumors.

This case study was loosely based on an actual case. Check it out here:
https://www.healio.com/ophthalmology/retina-vitreous/news/print/ocular-surgery-news/%7Bf470a7f9-ea6a-4d7b-aa89-445bc8341b7c%7D/woman-presents-with-progressive-decreasing-vision-in-both-eyes-and-new-onset-headaches 

Thanks for joining us for this week's Mystery Case and we hope to see you next week!