There are relatively few causes for tunnel visual fields (or “gun barrel” visual fields), which is a relatively common finding in neuro-ophthalmology. There are 8 major categories of tunnel visual fields, which can be determined systematically through careful history and examination. This differential diagnosis is adopted from Duane’s Clinical Ophthalmology.
4 Optic Nerve Causes of Tunnel Fields
- End-stage glaucoma
- End-stage papilledema (post-papilledema optic atrophy)
- End-stage optic nerve drusen
- Vigabatrin optic neuropathy
2 Retinal Causes of Tunnel Fields
- Retinitis pigmentosa and RP-like conditions
- Peripheral retinal scarring and degeneration (includes PRP scarring)
1 Intracranial Cause of Tunnel Fields (Bilateral)
- Bilateral occipital lobe infarcts with “macular sparing” (sparing of occipital tips)
Functional Vision Loss
- Glaser J. Chapter 5. Topical Diagnosis: Prechiasmal Visual Pathways. In: Duane’s Clinical Ophthalmology. In: Tasman W, Jaeger EA, eds. Duane’s Ophthalmology on CD-ROM, 6th Ed. Lippincott William & Wilkins, 2005.
- Ravindran J, Blunbergs P, Crompton J, et al. Visual field loss associated with vigabatrin: pathological correlations. Journal of Neurology, Neurosurgery & Psychiatry 2001;70:787-789.
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