Nasal field defect

Figure 34-3 Nasal field defect not confirmed on follow-up.

A 21-year-old woman developed acute irreversible loss of vision to 0.05 and a nasal visual field defect in the left eye 2 weeks after immunization with hepatitis A and B and yellow fever vaccine. An MRI scan showed hyper-intense thickening of the optic nerve, and a diagnosis of optic neuritis was made. Vision acuity did not recover but the scotoma disappeared within 6 weeks. 

A 43-year-old woman with hypertension and diabetes meUitns nsed 2-3 pnffs of oxymetazoline nasal spray and experienced painless blnrring of vision in the right eye, with a corrected acnity of 20/400 (20/50 on the left). Apart from backgronnd diabetic retinopathy she had edema of the optic disk. Several weeks later she nsed the spray again and this time developed blurred vision in the left eye. There was disk pallor on both sides and acuities were 20/400 on the right and 20/70 on the left. There were also segmental inferior field defects in both eyes. After 6 weeks both eyes had recovered somewhat, but only to 20/200 and 20/50 respectively there was no further improvement after a year. 

A 41-year-old man who had taken vigabatrin for 2 years in doses of 3-6 g/day developed bilateral concentric visual field defects, with greater loss in the nasal fields. Vigabatrin was withdrawn. Later he had a cardiopulmonary arrest and died. At postmortem there was peripheral retinal atrophy with loss of ganghon cells, severe in the peripheral retina and less severe in the maculae. 

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