[WEB SITE] Decreased vision on the left side leads to hemianopia diagnosis

Damage from stroke years ago prompts field loss today

April 22, 2015 By Madeline Bost, Christopher J. Borgman OD FAAO

A 39-year-old African-American female presented to The Eye Center at Southern College of Optometry with complaints of blurred vision, loss of side vision to the left, and trouble with mobility. She was diagnosed with hypertension, hypercholesterolemia, and type II diabetes mellitus in 2007 when she was admitted to the hospital for a stroke. The stroke left her with left-side weakness, and she occasionally suffered seizures. More recently, she had also reported being diagnosed with systemic lupus erythematosus. Her family ocular history was unremarkable—her paternal grandmother had diabetes, and her mother had hypertension. She smoked several times a week and reported no alcohol or recreational drug use. Her medications included prednisone, levetiracetum (Keppra, UCB), amitriptyline (Elavil, AstraZeneca), metformin, and simvastatin (Zocor, Merck). She reported an allergy to sulfa antibiotics. Blood pressure was measured manually in-office at 111/76 mm Hg.

Case presentation

Entering visual acuities were 20/70 OD and 20/400 OS, which improved with pinhole to 20/30 OD and 20/50 OS. Confrontation visual fields were restricted nasally OD and restricted in all gazes OS. Extraocular motilities were full in all gazes; cover test showed orthophoria at distance and near; and pupils were equal, round, reactive to light and accommodation with a positive afferent pupillary defect (APD) OS. Goldmann applanation tonometry was 19 mm Hg OD and 20 mm Hg OS. A new subjective refraction improved vision to a slow 20/20 in OU. Biomicroscopy was unremarkable OU. Examination of the posterior segment showed optic nerve pallor, more severe temporally OS compared to OD (see Figures 1 and 2). There was also lattice degeneration in the periphery OU but no signs of retinal breaks present. No diabetic retinopathy was noted OU.

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[WEB SITE] Vision Problems And Traumatic Brain Injury

What you need to know

• Your vision is important for many aspects of life.
• Traumatic brain injury (TBI) can cause problems with your vision.
• Treatment can either fix the problem completely, improve your vision, or help you better manage the problem.

What is vision and why is it important?

We often think about vision as being simply what we see. However, vision also includes how our brains make sense of what we see. Vision also helps other systems in the body work well. These include the systems for thinking and moving. When the visual system isn’t working properly, there can be a wide-ranging impact on our daily living activities (e.g., reading, driving, employment, school, and recreational activities) and quality of life. Depending on its location and severity, a TBI can affect your vision by damaging parts of the brain involved in visual processing and/or perception (e.g., cranial nerves, optic nerve tract or other circuitry involved in vision, occipital lobe).

How are vision problems found after TBI?

We often think about vision as being simply what we see. However, vision also includes how our brains make sense of what we see. Vision also helps other systems in the body work well. These include the systems for thinking and moving. When the visual system isn’t working properly, there can be a wide-ranging impact on our daily living activities (e.g., reading, driving, employment, school, and recreational activities) and quality of life. Depending on its location and severity, a TBI can affect your vision by damaging parts of the brain involved in visual processing and/or perception (e.g., cranial nerves, optic nerve tract or other circuitry involved in vision, occipital lobe).

The PDF Version

more –> Vision Problems And Traumatic Brain Injury.