Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Neuro-Ophthalmology

Case 5

Patient Presentation: A 44-year-old male was referred to a neuro-ophthalmology clinic for a new visual field defect. His visual acuity was 20/20 OU. OCT ganglion cell – inner plexiform layer (GCIPL) analysis is shown below.

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Question: Based on the OCT images, what visual field defect do you expect the patient present with?

A. Left homonymous quadrantanopia

B. Right homonymous quadrantanopia

C. Right homonymous hemianopia

D. Left homonymous hemianopia

Question: A right relative afferent pupillary defect was noted in the patient. Where does the lesion localize?

A. Left optic nerve

B. Optic chiasm

C. Left optic tract

D. Left occipital lobe

Question: Based on the retrochiasmal location of the lesion at the optic nerve tract, what type of deficit do you expect to see in OCT RNFL?

A. Bow tie atrophy

B. Unilateral deficit

C. Symmetric atrophy

D. Diffuse RNFL loss

Learning Objectives:

1. Describing the presentation and localization of homonymous hemianopia visual field defects

2. Recognizing bow-tie atrophy defects on RNFL OCT.