Chiasmal Glioma

TH is a 62-year-old man who saw his ophthalmologist with the complaint that his glasses were not adequately correcting his vision. Examination found visual acuity at the 20/50 level in both eyes and a mild nuclear sclerotic cataract bilaterally. His reduced vision was attributed to the cataracts and he was offered surgery, but the patient stated he functioned adequately in daily life and opted to return in a year. A few months later he experienced severe headaches and sought care at the local emergency room. An MRI scan was performed and a large pituitary tumor was identified with chiasmal compression (Fig. 159). He was sent to a neuro-ophthalmologist for baseline testing before neurosurgery was scheduled to remove the tumor.

The consultant recorded bilateral temporal optic disc pallor and a visual field documented a severe bitemporal field defect.