|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 7 | Page : 832-833
Isolated complete bitemporal hemianopia in traumatic chiasmal syndrome
Swati Phuljhele1, Savleen Kaur2
1 Assistant professor, Advanced eye centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Senior Resident, Advanced eye centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||13-Aug-2014|
Room No 116, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Phuljhele S, Kaur S. Isolated complete bitemporal hemianopia in traumatic chiasmal syndrome. Indian J Ophthalmol 2014;62:832-3
|How to cite this URL:|
Phuljhele S, Kaur S. Isolated complete bitemporal hemianopia in traumatic chiasmal syndrome. Indian J Ophthalmol [serial online] 2014 [cited 2020 Apr 9];62:832-3. Available from: http://www.ijo.in/text.asp?2014/62/7/832/138649
We read with great interest the article by Kim DW et al.  in the previous issue of your esteemed journal. We congratulate the authors for highlighting a rather complex but rather known entity, i.e. the traumatic chiasmal syndrome or the optic chiasmal cleavage syndrome. We share our experience with a report of five cases of blunt head trauma. The patients had no radiologically detected abnormality of the visual pathway, presented to the neuro-ophthalmology clinic at a tertiary eye center, without any neurological signs but had bitemporal hemianopia on visual field examination [Table 1].
|Table 1: A profile of the five cases diagnosed with traumatic chiasmal syndrome|
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As rightly pointed out by the authors, those few who survive the impact of chiasmal damage after severe head trauma develop a variety of neurological signs. We found no neurological abnormality in the five cases that we reviewed. Two out of the five had accompanying skull fractures. Literature reports nearly two-third of these patients might have associated skull fractures.  Intracranial hemorrhages are also common.  As far as the visual acuity is concerned, three out of the five had visual acuity better than 6/12. In the past series described in the literature, nearly 70% patients have good visual acuity (>6/12), , although some patients may have poor vision. The deteoration in visual acuity depends upon the extent of damage to the anterior visual pathway. Some of these patients may end up with total loss of vision in one eye with temporal loss in the other. All our patients had bitemporal hemianopia due to trauma that was complete as compared with other chiasmal syndromes. 
Chiasma can be injured in upto 4.4% cases of trauma.  In the presence of bitemporal hemianopia, one would expect other neurological abnormalities in the form of cranial nerve palsies and hypothalamus and pituitary abnormalities. However, absence of any such finding, as in our cases, can also be observed.
| References|| |
Kim DW, Kim US. Isolated complete bitemporal hemianopia in traumatic chiasmal syndrome. Indian J Ophthalmol 2013;61:759-60.
Hassan A, Crompton JL, Sandhu A. Traumatic chiasmal syndrome: A series of 19 patients. Clin Experiment Ophthalmol 2002;30:273-80.
In: Miller NR, Newman NJ, editors. The Essentials: Walsh and Hoyt's Clinical Neuro-Ophthalmology. 5 th
ed. Baltimore: Williams and Wilkins; 1998. p. 715-39.
Heinz GW, Nunery WR, Grossman CB. Traumatic chiasmal syndrome associated with midline basilar skull fractures. Am J Ophthalmol 1994;117:90-6.
Hughes B. Indirect injury of the optic nerves and chiasma. Bull Johns Hopkins Hosp 1962;111:98-126.