Neuro-Ophthalmic
Homonymous Hemianopia
Also known as: homonymous hemianopia, homonymous field defect, same side field loss both eyes, post-chiasmal field loss, stroke visual field loss
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Loss of the same half of the visual field in both eyes from damage behind the chiasm, so the defect respects the vertical meridian. Patients bump into objects or lose text on one side, and the eye examination itself can be entirely normal. Onset decides management: an acute defect is a stroke presentation warranting emergency referral, while a longstanding one moves to rehabilitation and a fitness-to-drive conversation.
Recognition
Symptoms: what patients report
- Same-side field loss affecting both eyes.
- Patient may bump into objects or miss text on one side.
- Acute onset should increase concern for stroke or other neuro pathway urgency.
- Diplopia with neurologic symptoms or a homonymous field pattern should keep cortical or brainstem disease visible.
Signs: what the examination shows
- Homonymous field pattern on formal testing.
- Defect respects the vertical meridian.
- Associated neurologic features may or may not be present.
What OptoGuide™ covers for homonymous hemianopia
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Homonymous Hemianopsia — NANOS
- The Neuro-Ophthalmology Survival Guide (Pane, Miller & Burdon) — standard reference text
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.