1. Junctional scotoma. A 24-year-old woman with multiple sclerosis described a progressive fogginess of vision in her left eye. The visual acuity was 20/20 in the right eye and 20/200 in the left eye. The optic discs were normal in appearance. Humphrey perimetry on presentation revealed the expected central scotoma in the left eye, but also a surprising temporal visual field defect in the right eye, constituting a junctional scotoma (top). Magnetic resonance imaging (MRI) demonstrated demyelination at the junction of the left optic nerve and anterior chiasm, where some of the nasal fibers crossing from the right optic nerve (representing the temporal field) are also affected. The patient improved without treatment, although high-dose intravenous steroids were considered. The visual fields reveal resolution of the temporal visual defect in the right eye and marked improvement in the central scotoma in the left eye (bottom). The visual acuity eventually recovered to 20/30.
Source: Understanding Visual Field Defects, Practical Neuroophthalmology
Citation: Martin TJ, Corbett JJ. Practical Neuroophthalmology; 2013 Available at: Accessed: November 09, 2017
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