Tunnel vision

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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44 Tunnel vision

Instruction

Examine this patient’s eyes.

Examine this patient’s visual fields.

Salient features

• Intact central vision with constriction of the peripheral fields

• Proceed by examine for the following:

• optic atrophy (primary and secondary)
• retinitis pigmentosa (p. 723)
• choroidoretinitis (p. 726)
• glaucoma.

Diagnosis

This patient has tunnel vision (lesion) as a result of retinitis pigmentosa (aetiology).

Advanced-level questions

What are the other causes of tunnel vision?

• Hysteria

• Slight contraction of field occurs when there is a significant refractive error.

Note: Before making a diagnosis of hysteria, contraction of the visual fields caused by extreme fatigue, poor attention, inadequate vision, diminished visual acuity or delayed reaction time must be excluded.

How would you differentiate hysteria from an organic cause of tubular vision?

In organic causes, the field of vision widens progressively as the test objects are held further away from the eye, but in the hysterical person this widening is not seen and the entire width of the field is as great at 1 foot (30 cm) from the eye as it is at 5, 10 or 15 feet (1.5, 3, or 4.5 m).

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44 Tunnel vision

Instruction

Examine this patient’s eyes.

Examine this patient’s visual fields.

Salient features

• Intact central vision with constriction of the peripheral fields

• Proceed by examine for the following:

• optic atrophy (primary and secondary)
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