Visual Field Defects

Key points

• Bitemporal hemianopia: chiasmal lesion — pituitary tumour, craniopharyngioma.
• Homonymous hemianopia: retrochiasmal — optic tract/radiation/occipital cortex.
• Upper quadrantanopia ('pie in the sky'): temporal lobe (Meyer's loop); lower quadrantanopia ('pie on the floor'): parietal lobe.
• Central scotoma: optic nerve/macula (optic neuritis, toxins).
• Macular-sparing homonymous hemianopia suggests occipital (posterior circulation) infarct.

Decision points in this pathway

• Quadrantanopia?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.