Neuro-ophthalmology: Case sixteen

This 52 year-old woman was referred by his optician because of abnormal visual fields. Her intraocular pressure in both eyes were normal at 17mmHg. Fundoscopy revealed the above appearance in both eyes (the above picture is from the right eye).

a. What does the picture show?

Tilted disc with inferior juxtapapillary crescent.

It is a congenital condition and is always bilateral. It results from the oblique insertion of the optic nerves into the globe. It may be associated with optic nerve hypoplasia.

b. What type of visual field defect may be present?

Supero-temporal field loss is typically seen. This defect is the result of decreased nerve fibres inferonasally.

The defects can cause bitemporal hemianopia but does not respect the vertical midline. It is important to recognize this and does not put the patient through unnecessary investigation for pituitary tumour.

c. What other ocular findings would you expect to find in this condition?
Other ocular findings include:
  • myopia with astigmatism
  • slightly decreased visual acuity even with full refractive correction
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