Unexplained Visual Field Loss: Causes and Insights

Unexplained visual field loss

Hello Doctor, last December I experienced a fist-sized visual field defect in my right eye, specifically in the nasal peripheral vision (25-40 degrees).
Despite seeking medical attention, the cause of this defect remains undetermined.
The obscuration varies with light exposure; under white light, bright illumination, or during the day, the obscuration becomes more pronounced, often accompanied by a white haze or dark shadow (reacting to light intensity), making it difficult to see my fingers.
In a dark room or under yellow light at night, the symptoms lessen (I can see my fingers).
Previous examinations, including fundus examination, fluorescein angiography, and OCT, revealed no abnormalities in the eye.
I consulted a neurosurgeon, who ruled out the influence of a pituitary tumor.
The neurosurgeon also conducted a head CT and MRI.
I have a history of floaters, and some doctors believe this may be due to vitreous degeneration, which could explain the varying light reactions and symptom changes.
However, since the location of my defect is fixed, I am skeptical about this explanation, as floaters caused by vitreous degeneration typically drift unpredictably.
At 18, I suffered a macular hemorrhage in my right eye due to external trauma, but my vision returned to 0.9-1.0 after the hemorrhage resolved.
Currently, I do not experience any obscuration or distortion in my central vision when viewing objects.
Most doctors believe this is unrelated to the old macular injury.
There have been no significant changes over the past year, but I kindly request your guidance on potential diagnostic directions.
Thank you.

zhihui, 30~39 year old female. Ask Date: 2011/12/14

Dr. Wang Zhangji reply Ophthalmology

In bright light, the pupils constrict.
If there is localized opacification in the lens, it may obstruct the visual field.
When the light diminishes, the pupils dilate, allowing light to enter from the periphery to compensate.
However, you mentioned that this is no longer occurring, which is not consistent with the condition of cataracts.

Reply Date: 2011/12/14

More Info

Understanding unexplained visual field loss can be a complex and concerning issue, particularly when the symptoms are persistent and the underlying causes remain elusive. Based on your description, it appears that you are experiencing a significant visual field defect in your right eye, specifically in the nasal peripheral vision. The fact that this defect is responsive to light conditions, becoming more pronounced under bright light and less noticeable in dim environments, adds another layer of complexity to your situation.

Visual field loss can arise from a variety of causes, including retinal issues, optic nerve problems, or neurological conditions. Given that you have undergone extensive examinations, including fundus examinations, fluorescein angiography, optical coherence tomography (OCT), and imaging studies like CT and MRI, it is reassuring that no significant abnormalities have been detected in these areas. This suggests that the issue may not be directly related to the retina or optic nerve, but rather could be linked to other factors.

One possibility that has been suggested is vitreous degeneration, which can lead to symptoms such as floaters and changes in visual perception. However, as you rightly pointed out, vitreous degeneration typically results in moving spots or floaters rather than a fixed visual field defect. The fact that your visual field loss is localized and does not change position suggests that it may not be solely attributable to vitreous changes.

Your history of a prior retinal hemorrhage in the right eye raises the question of whether there could be residual effects from that incident. While most patients recover well from such events, there can be lingering effects that may not be immediately apparent. The absence of current retinal abnormalities does not entirely rule out the possibility of previous damage influencing your current symptoms.

Another consideration is the potential for neurological causes of visual field loss. Although you have consulted with a neurosurgeon and ruled out significant conditions such as pituitary tumors, it may be worthwhile to explore other neurological assessments. Conditions such as visual field defects due to cortical lesions or other neurological pathways could be contributing to your symptoms.

In terms of management, it is essential to continue monitoring your condition closely. If your symptoms remain stable, regular follow-ups with your ophthalmologist and possibly a neurologist may be advisable. They can help ensure that any changes in your condition are promptly addressed. Additionally, if you experience any new symptoms, such as changes in vision, headaches, or other neurological signs, it is crucial to seek immediate medical attention.

In summary, unexplained visual field loss can be a challenging issue to diagnose and manage. While your extensive evaluations have not revealed clear causes, it is essential to remain vigilant and continue working with your healthcare providers to explore all potential avenues. Keeping a detailed record of your symptoms, including any changes in light conditions or visual perception, can also be beneficial for your medical team in understanding your condition better.

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