Synopsis
Use the distribution and time course of visual-field loss to localise disease, recognise vascular and pituitary emergencies, and guide investigation and rehabilitation.
- Monocular field loss usually localises to the retina or optic nerve before the chiasm.
- Bitemporal loss suggests optic-chiasm dysfunction and requires assessment for a sellar or suprasellar lesion.
- A homonymous defect affects the same side of visual space in both eyes and localises behind the chiasm on the opposite side.
Key red flags
Abrupt persistent loss of one side of the visual world requires emergency stroke assessment even when speech and limb strength are normal.
Investigation priorities
Localise the deficit and identify emergency pathways without waiting for formal testing.
Management branches
A new monocular or homonymous deficit remains present or accompanies acute neurological symptoms.
- Activate emergency assessment, document symptom timing and ensure the patient does not drive to hospital.
- Distinguish monocular from homonymous loss at the bedside while preserving rapid access to stroke and ophthalmic expertise.
Key medicines
Aspirin for suspected TIAGive 300 mg orally once daily immediately unless contraindicated, pending urgent specialist assessment and the resulting secondary-prevention plan.
Hydrocortisone for emergency pituitary apoplexyThe Society for Endocrinology emergency guidance includes 100 mg intramuscularly immediately, followed by 50–100 mg intramuscularly every six hours; continued route and dosing are directed by the emergency endocrine team.