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Scotoma: Causes, Symptoms & Treatment

A scotoma is a defined area of partial or complete vision loss within the visual field. It can be a sign of various eye or neurological conditions.

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Things worth knowing about "Scotoma"

A scotoma is a defined area of partial or complete vision loss within the visual field. It can be a sign of various eye or neurological conditions.

What is a Scotoma?

A scotoma (from the Greek skotos, meaning darkness) is a circumscribed area within the visual field where vision is partially or completely absent. In an absolute scotoma, no light or image is perceived at all, while a relative scotoma involves reduced but not absent vision in the affected area. Scotomas can occur in one or both eyes and vary in size, shape, and location.

Types of Scotomas

Absolute scotoma: Complete loss of vision in the affected area; no light stimulus is perceived.
Relative scotoma: Reduced vision in the affected area, but not completely absent.
Central scotoma: The defect is located at the center of the visual field, severely impairing sharp, detailed vision.
Paracentral scotoma: The defect lies just outside the central fixation point.
Blind spot (physiological scotoma): Every person has a natural blind spot where the optic nerve exits the eye. This is normally not consciously perceived.
Scintillating scotoma: A flickering, arc-shaped visual phenomenon typically associated with migraine with aura.

Causes

Scotomas can result from a wide range of conditions:

Eye diseases: Glaucoma, macular degeneration, diabetic retinopathy, retinal detachment, optic neuritis
Neurological conditions: Multiple sclerosis, stroke, brain tumors, increased intracranial pressure
Migraine with aura: Temporary, often flickering scotomas that expand and resolve within minutes
Vascular disorders: Impaired blood flow to the retina or optic nerve
Medications and toxins: Certain drugs or toxic substances can induce scotomas as a side effect

Symptoms

People with scotomas often describe a dark, gray, or black spot in their field of vision. Some scotomas are actively noticed, while others only become apparent through difficulty reading or blurred vision. Additional symptoms may occur depending on the underlying cause, such as headache, light sensitivity, or other visual disturbances.

Diagnosis

Several diagnostic methods are available to assess scotomas:

Perimetry (visual field testing): The primary method for detecting and mapping visual field defects. A perimeter presents light stimuli at various positions in the visual field and records the patient's responses.
Ophthalmoscopy: Examination of the fundus of the eye to detect changes in the retina and optic nerve.
Optical coherence tomography (OCT): Detailed cross-sectional imaging of retinal layers.
Brain MRI: Performed when a neurological cause is suspected, to visualize brain structures.

Treatment

Treatment depends on the underlying cause:

In glaucoma, intraocular pressure is reduced using eye drops, laser therapy, or surgery.
In optic neuritis (e.g., related to multiple sclerosis), corticosteroids are commonly administered.
In vascular disorders, appropriate internal medicine or neurological treatment is initiated.
Migraine-related scotomas are usually temporary and resolve on their own; however, the migraine itself can be treated with appropriate medication.
For irreversible damage, such as advanced macular degeneration, rehabilitative measures like magnifying visual aids play a central role.

When to See a Doctor?

Any newly appearing or enlarging visual field defect should always be evaluated by an ophthalmologist promptly. Sudden onset of a scotoma is a medical emergency, as conditions such as stroke or retinal detachment must be ruled out immediately.

References

Grehn, F.: Augenheilkunde (Ophthalmology). 32nd edition. Springer Medizin Verlag, Heidelberg, 2019.
Burde, R. M., Savino, P. J., Trobe, J. D.: Clinical Decisions in Neuro-Ophthalmology. 3rd edition. Mosby, St. Louis, 2002.
World Health Organization (WHO): International Classification of Diseases (ICD-11). Available at: https://icd.who.int (accessed 2024).

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