Case 6

Patient Presentation: A 54-year-old female was seen in the emergency department for a new-onset severe headache and visual field deficit OU. The patient noted that she believes she cannot see in her periphery as well as normal. The patient’s vision was 20/40 OD and 20/25 OS. Colour vision was 9/14 OD, 12/14 OS on Ishihara plates. No RAPD was noted.  Dilated eye examination was normal. The OCT RNFL and GCC are shown below:

Neuro-Ophthalmology 6-1.png

Question: What pathology is found in the above RNFL/GCIPL OCT images?

Question: What is the next best step in evaluating this this patient in the eye clinic?

Question: Based on visual field results and the patient presentation, what is the most likely cause of her symptoms?

Learning Objectives:

1. Describe the findings on visual field and OCT with acute pituitary apoplexy

2. Time is necessary for OCT to thin compared to visual field deficit in compressive lesions