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February 1974

Chiasmatic Lesions

Author Affiliations

Cambridge, Mass

Arch Ophthalmol. 1974;91(2):168. doi:10.1001/archopht.1974.03900060174020

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To the Editor.  —In reference to the article by Brais and Drance in the Archives titled "The Temporal Field in Chronic Simple Glaucoma" (88:518, 1972), nowhere was the possibility of a chiasmatic lesion producing the temporal field loss mentioned. Admittedly, glaucoma producing inferior nasal cupping produces a corresponding superior temporal defect. However, chiasmatic lesions can be absent for a long time before clinical symptoms are apparent. These usually begin with a temporal field loss.Can we be 100% certain that an aneurysm or pituitary tumor is not lurking in the background? Would one consider a complete neurological examination and skull x-ray films to be an initial screening procedure in an asymptomatic patient with glaucoma whose discs do not show the characteristic cupping?

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