Idiopathic binasal hemianopia: case report and literature review

Abstract

A 56-year-old lady was referred for complete binasal hemianopia noticed during routine glaucoma screening. On examination the patient was asymptomatic, there were no ophthalmic causes explaining her visual field defect and further neurologic investigation was normal. Binasal hemianopia is an uncommon finding that is usually associated to intraocular conditions, but may rarely be caused by neurologic diseases. The Authors also review the current ophthalmic literature about binasal hemianopia in patients with otherwise complete neurologic and ophthalmic investigation (idiopathic binasal hemianopia).

False Positive Hemianopia

“…Detailed consideration of the case presents a series of reasons to regard the automated visual field report with skepticism: 1. The automated visual field suggests a binasal hemianopia, an uncommon abnormality most often a result of such bilateral ocular diseases as optic nerve pathologies -ischemic optic neuropathy, optic nerve head drusen, glaucoma, bilateral optic nerve pits, papilledema, or optic atrophy [1,2]. Retinal diseases, including retinitis pigmentosa sine pigmento [1] or corneal pathology as keratoconus [3], have also described as possible causes of binasal defect.…”

“…Retinal diseases, including retinitis pigmentosa sine pigmento [1] or corneal pathology as keratoconus [3], have also described as possible causes of binasal defect. In rare cases, binasal hemianopia has been attributed to neurological etiologies, including bilateral internal carotid artery aneurysms or atherosclerosis [4], hydrocephalus [5], olfactory groove meningioma [5], intracranial mass lesions, and pituitary apoplexy [1]. Pringle et al [6] reported a case of progressive binasal visual field loss due to neurosyphilis.…”

“…Binasal hemianopia is an uncommon abnormality that is most often due to bilateral ocular disease such as keratoconus, ischemic optic neuropathy, optic nerve head drusen, glaucoma, bilateral optic nerve pits, and retinitis pigmentosa sine pigmento [1, 2]. Binasal hemianopia is rarely attributable to neurological etiologies, including bilateral internal carotid artery aneurysms, hydrocephalus, intracranial mass lesions, and pituitary apoplexy [1].…”

Binasal hemianopia caused by bilateral optic perineuritis due to sarcoidosis

“…The underlying causes of BNH can be classified into three categories according to the anatomical location, (i) ocular lesions, such as keratoconus, glaucoma, drusen, and retinitis pigmentosa, (ii) optic nerve lesions including optic chiasm, such as syphilitic ON, ischemic optic neuropathy, internal carotid artery aneurysm and atherosclerosis, pituitary apoplexy, pneumosinus dilatans, and olfactory groove meningioma, (iii) intracranial lesions, such as brain tumor, the elevation of intracranial pressure, and occipital lobe lesions [ 6 , 7 ]. Salinas-Garcia et al reported in 75% of cases with BNH originate from ocular lesions or optic nerve [ 8 ].…”

“…Unlike homonymous and bitemporal hemianopia, BNH is a rarely encountered neuro-ophthalmological finding. Since visual signals from the nasal visual fields do not cross but pass through the lateral nerve fibers at the optic chiasm, bilateral temporal optic nerve fiber lesions or uncrossed optic nerve fibers should be considered as responsible lesions of BNH [ 6 , 7 ]. Here, we describe a case of BNH secondary to bilateral OPN presumably caused by sarcoidosis, which to our knowledge, is the first such report in the literature.…”