Chiasmal compression misdiagnosed as normal-tension glaucoma: can we avoid the pitfalls?

Area of Science:

• Ophthalmology
• Neurology
• Endocrinology

Background:

• Routine neuroimaging for normal-tension glaucoma (NTG) is debated due to low intracranial pathology detection rates.
• However, compressive lesions affecting visual pathways are found in approximately 8% of NTG patients.

Observation:

• Three cases are presented where initial NTG diagnosis was revised to chiasmal compression from pituitary tumors.
• Patient 1: 79yo female with bitemporal hemianopia and pituitary tumor. Patient 2: 83yo male with routine MRI revealing pituitary tumor. Patient 3: 52yo male with progressive visual field loss and pituitary tumor.

Findings:

• All patients exhibited signs retrospectively suggestive of intracranial pathology, warranting earlier neuroimaging.
• Key indicators include bitemporal field loss, optic disc pallor, reduced color vision, and poor correlation between disc and visual field findings.

Implications:

• While uncommon, anterior visual pathway compression should be considered in NTG suspects.
• Clinicians should maintain a high index of suspicion for intracranial mass lesions when specific visual field and optic disc anomalies are present.