Central scotoma

43 Central scotoma

Instruction

Examine this patient’s visual fields.

Salient features

History

• Sudden onset usually

• Patient notices a ‘hole’ in the vision while reading a poster or looking at a clock

• Difficulty performing in reading, driving, walking and recognizing faces.

Examination

• Central scotoma (allow the patient to find the defect by moving the white hat pin in his or her own visual field). Then determine:

• the size and shape of the defect by moving the pin in and out of the blind area

• whether the defect crosses the horizontal midline (vascular defects of retina do not do so)

• whether the defect crosses the vertical midline (defects caused by pathway damage have a sharp vertical edge at the midline)

• whether the defect extends to the blind spot: so-called caecocentral scotoma (seen in glaucoma, vitamin B₁₂ deficiency) (Fig. 43.1)

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Tags: 250 Cases in Clinical Medicine

Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off

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