Bitemporal hemianopia
There is bitemporal hemianopia which obeys the midline (the hemianopia may be worse in one eye than the other or denser superiorly or inferiorly). This suggests a lesion in the optic chiasm.

In the examination:

  • The hemianopia may be subtle and revealed only by comparing two red objects in each hemifield. The red colour in the temporal field appears washed out.
  • If the hemianopia does not obey midline consider pseudo-bitemporal hemianopia such as bilateral sectorial retinitis pigmentosa, tilted discs or bilateral inferotemopral retinoschisis. Mention that you would like to examine the fundi for any such changes.
  • Features of pituitary abnormalities such as acromegaly, pan-hypopituitarism (smooth skin and absence body hair in male)
  • Look for any scar suggestive of pituitary operation.