65 year old with 20/200 vision c/o loss of peripheral vision

Posted by - Posted on 06/19/2017 20:05:48 Glaucoma Neuro ophthalmology

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60 year old with black man presents with gradual loss of peripheral vision; IOP 12 mm HG OU on no meds.  Optic nerve and OCT attched. How do you like to work up this patient ?

What is teh differental diagnosis?

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Michael Puente 06/30/2017 04:11:15

The visual fields suggest diffuse vision loss in both eyes, and the MRI shows a mass in the area of the chiasm. The patient likely has some form of pituitary adenoma and needs to be referred to neurosurgery and endocrinology.

MediTred Admin 06/24/2017 17:33:02

Dr A: Good discussion so far. We did do the serial tonometry and red color testing was done. IOP was below 20 through out the day. Red color was described as red and the patient could not tell us if the the red was dark or dull. Please review the MRI and the attached HVF. Where do we go from here?

Alex Yelenskiy 06/24/2017 00:25:52

Good point Josh!. I would definitely order MRI....stat, as well as visual fields. If normal, I would then do a comprehensive glaucoma work-up.

Nishika Muddasani 06/24/2017 00:24:22

I would also check color vision with ishihara, ask about family history, check serial tonometry and get pachymetry. DDx normal tension glaucoma vs compressive optic atrophy from a tumor vs other causes of optic neuropathy (toxic, vascular, inflammatory).

Joshua Ford 06/23/2017 23:03:12

Bilateral nerves appear to have significant rim loss as well as pallor (and thinning on OCT RNFL) in the context of normal IOP. Concerned about normal tension glaucoma vs (even more concerning) tumor (such as pituitary adenoma) given significant pallor of both nerves. Would order visual field to assess for glaucomatous deficits as well as brain imaging (MRI)