Objective:

To describe a unique case of incidentally discovered bitemporal hemianopsia from a traumatic optic chiasmopathy.

Background:

Traumatic chiasmopathy is a rare condition most commonly characterized by bitemporal hemianopsia. Injuries reported span from minor tears to, less commonly, a complete transection.  The predominant mechanism of damage to the optic chiasm in traumatic chiasmopathy is high-velocity closed head injuries to the frontal area that may result in direct tearing of crossing axons.

Design/Methods:

NA

Results:

An optometrist referred an 81-year-old male to neuro-ophthalmology after incidentally discovering bitemporal hemianopsia. Only notable history was a snowmobile collision in the 1970s. He did not recall any vision complaints after the collision. Magnetic resonance imaging (MRI) of the pituitary revealed a complete bisection of the optic chiasm and encephalomalacia in the right anterior frontal lobe and left anterior temporal lobe, consistent with prior head trauma. Perimetry using Humphrey visual field (HVF) analyzer demonstrated bitemporal visual deficits. Considering the results of his imaging studies and the lack of functional impairment, we did not recommend any additional diagnostic testing and treatment.

Conclusions:

Patients who develop bitemporal hemianopsia as a result of traumatic optic chiasmopathy may have developed coping maneuvers to compensate for their deficits. This patient case highlights the importance of patient education regarding head trauma and reporting of symptoms. Providers should also perform detailed neurologic examinations and the indicated diagnostic tests to identify visual field disturbances.