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Hemianopia: Causes, Symptoms and Treatment
Hemianopia is the loss of vision in one half of the visual field in one or both eyes. It is usually caused by brain damage and requires prompt medical evaluation.
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Hemianopia is the loss of vision in one half of the visual field in one or both eyes. It is usually caused by brain damage and requires prompt medical evaluation.
What is Hemianopia?
Hemianopia (also spelled hemianopsia) refers to the complete loss of vision in one half of the visual field. People affected by this condition cannot perceive anything on either the left or right side of their visual field. In some cases both eyes are affected equally; in others only one eye is involved. Hemianopia is not a primary eye disease – it is typically caused by damage to the visual pathway within the brain.
Causes
Hemianopia results from damage along the visual pathway, which carries signals from the eyes to the visual cortex in the occipital lobe of the brain. Common causes include:
- Stroke: The most frequent cause; reduced blood flow to the brain can destroy parts of the visual pathway.
- Brain tumors: Benign or malignant tumors may compress or damage the optic tract or visual cortex.
- Traumatic brain injury: Injuries to the back of the skull can result in visual field defects.
- Multiple sclerosis: Inflammatory demyelinating lesions may affect the optic pathway.
- Migraine with aura: Temporary, reversible hemianopia can occur as part of a visual aura.
- Pituitary tumors: These can press on the optic chiasm, causing bitemporal hemianopia.
Types of Hemianopia
Homonymous Hemianopia
Homonymous hemianopia occurs when the same side of the visual field is lost in both eyes (e.g., the right half in both eyes). It results from lesions located behind the optic chiasm, in the optic tract, lateral geniculate nucleus, optic radiation, or visual cortex. Stroke is the most common underlying cause.
Heteronymous (Bitemporal) Hemianopia
Bitemporal hemianopia refers to the loss of the outer (temporal) visual fields in both eyes. It typically results from compression of the optic chiasm, most commonly by a pituitary adenoma.
Quadrantanopia
Quadrantanopia is a partial form of hemianopia in which only one quarter of the visual field is lost. It is usually caused by damage to the optic radiation or the visual cortex.
Symptoms
The symptoms of hemianopia depend on which side and how much of the visual field is affected. Typical complaints include:
- Bumping into objects or people on the affected side without noticing them
- Difficulty reading, especially when moving to the next line or finding words
- Problems with driving or navigating in traffic
- Frequently overlooking items on one side
- A general feeling of having a restricted field of view
Many patients are initially unaware of their visual field loss, as the brain partially compensates for the missing area.
Diagnosis
Hemianopia is diagnosed through visual field testing (perimetry), which systematically maps the boundaries of the visual field. Key diagnostic steps include:
- Confrontation perimetry: A simple bedside or office test performed by the clinician
- Automated perimetry: Computer-assisted, precise mapping of the visual field
- Brain MRI: To identify and locate the lesion within the visual pathway
- Brain CT: Particularly useful in acute settings such as trauma or stroke
- Ophthalmological examination to rule out primary eye disease
Treatment
Treatment of hemianopia depends on the underlying cause:
- Stroke: Acute treatment with thrombolysis or mechanical thrombectomy; followed by neurorehabilitation
- Tumor: Neurosurgical removal, radiation therapy, or medical treatment depending on tumor type
- Inflammatory conditions (e.g., multiple sclerosis): Immunotherapy and corticosteroids
In addition to treating the underlying cause, rehabilitative measures play an important role:
- Visual compensation training: Exercises to improve eye movements toward the blind field and enhance scanning strategies
- Prism glasses: Special lenses that optically shift the visual field to improve orientation and safety
- Occupational therapy: Support for daily activities such as reading and independent mobility
- Neuropsychological rehabilitation: Cognitive support for patients with additional brain function impairments
Complete recovery of hemianopia is rare, but spontaneous improvement can occur, especially in the first weeks after a stroke. Regular follow-up with an ophthalmologist and a neurologist is strongly recommended.
References
- Trobe JD. The Neurology of Vision. Oxford University Press, 2001.
- Zhang X, Kedar S, Lynn MJ et al. Homonymous hemianopia in stroke. J Neuroophthalmol. 2006;26(3):180-183.
- World Health Organization (WHO): Rehabilitation of people with visual impairment. www.who.int
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