Open AccessBinasal congruous hemianopia secondary to functional visual loss
Author(s) -
Georgios Tsokolas,
Hina Khan,
Straton Tyradellis,
Jithin George,
Mark Lawden
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000020754
Subject(s) - medicine , visual field , blind spot , visual acuity , ophthalmology , optometry , psychology , neuroscience
To describe an unusual case of binasal congruous hemianopia secondary to functional visual loss (FVL). Patient concerns: A 24 year-old male was referred originally by his optician at the Emergency Eye Department of the Leicester Royal Infirmary in October 2018 with visual field changes affecting the nasal field of vision in both eyes on routine eye examination. The patient reported ongoing headaches over the last 6 weeks to 8 weeks associated with simultaneous peripheral visual field changes. He also reported rapid loss of weight over the same period of time. Diagnosis: Binasal congruous hemianopia secondary to FVL. Interventions: Full past medical and ocular history was obtained. The patient underwent full ophthalmic examination including dilated fundoscopy. Visual acuity was recorded with Snellen Chart. Color vision was assessed with Ishihara plates. Peripheral vision was assessed with both Humphrey visual fields and Goldmann visual fields. Optical coherence tomography of the macula and discs was also performed. Neuroimaging investigations included Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) of the Brain. Electrophysiology investigations included Electroretinogram and visual evoked potentials. Patient was also tested for syphilis. Outcomes: Humphrey visual fields and Goldmann visual fields confirmed the presence of complete binasal field defects. Optical coherence tomography, electroretinogram, visual evoked potentials, CT, MRI were all unremarkable. Ocular examination was normal. Finally, syphilis serology was negative. After 1 year of follow-up, the visual field changes have remained the same. Conclusion: To the best of our knowledge, this is the fourth case described in the literature with complete congruous binasal hemianopia due to FVL. We advocate thorough investigations with multimodal imaging of the fundus, neuroimaging and syphilis serology to exclude serious organic causes for binasal field defects prior to labeling such a field defect functional. Such patients may benefit from neuropsychological input to understand the psychological factors that may be contributing to the symptoms.