Peripheral scotoma

Specialty: Ophthalmology.

• loss of peripheral vision
• tunnel vision
• peripheral visual field restriction

Why it occurs

• Advanced chronic open angle glaucoma
• Retinitis pigmentosa or other peripheral photoreceptor dystrophies
• Peripheral retinal detachment
• Branch occlusion of the central retinal artery
• Arteritic anterior ischemic optic neuropathy (AION-A)
• Injury to the postchiasmatic visual pathway (cerebral hemisphere)

Initial workup

Standard computerized campimetry (30-2 strategy or full peripheral visual field); Goldmann applanation tonometry to check intraocular pressure; Indirect ophthalmoscopy with scleral indentation under maximal pharmacological mydriasis to closely inspect the peripheral retina for tears or tractions; B-mode ocular ultrasound if media opacity (e.g., dense cataract or vitreous hemorrhage) precludes direct visualization.

Standard management

• Latanoprost — 0.005% eye drops, prostaglandin analogue, 1 drop at night in the conjunctival sac to reduce intraocular pressure by increasing the uveoscleral outflow tract in patients with glaucoma
• Timolol — 0.5% eye drops, non-selective beta blocker, 1 drop every 12 hours to reduce the secretion of aqueous humor
• Brimonidine (0.2% eye drops, alpha-2 adrenergic agonist, 1 drop every 12 hours as a second-line ocular hypotensive agent with potential peripheral neuroprotective effect).