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To understand these field defects, its necessary to know how the eye processes the visual field. Unilateral deficits are caused by retinal and optic nerve disease. Am J Ophthalmol. Just consider the cycloplegic effects of the dilating drops when determining which trial lens to use in patients who are not yet absolute presbyopes. (F) Paralysis of upward gaze and convergence (Parinauds syndrome). Acute Monocular Quadrantanopia and Retinal Diseases HVr6}WX0. Nystagmus Types - StatPearls - NCBI Bookshelf Philadelphia: Mosby, 1998. When patients display other neurological symptoms, an immediate referral is required. In other cases, medical evaluation and treatment are necessary; vertebrobasilar insufficiency (VBI) and ocular ischemic syndrome (OIS) secondary to internal carotid artery insufficiency are far more serious potential causes of transient binocular (caused by VBI) and monocular (caused by OIS) scotomas. 2007 May;143(5):772-80. A normal scan sometimes turns out to be not so normal when re-evaluated with more critical parameters! He was alert and *Images generated. Superior right quadrantanopia. Optic nerve and significant retinal disease in one eye can create color vision disturbances and positive RAPD results in that eye. Headache and photophobia have also been known symptoms[4]. WebThe syndrome of visuospatial neglect is a common consequence of unilateral brain injury. Baltimore, Williams &. It is called the rostral interstitial nucleus of the MLF and is associated with Parinaud's syndrome (see Figures 14-3A and 17-4F). Functional visual loss in adults and children: patient characteristics, management, and outcomes. left, O.D. Post-geniculate fibers split into superior and inferior pathways, traveling through the parietal and temporal lobes, respectively, as they course posteriorly in the brain. THE VISUAL PATHWAY (Figure 17-1) includes the following structures. This occurs from a lesion where the optic nerve and chiasm meet and can present with varying field defects in the monocular, ipsilateral eye[14]. 2. and 20/200 O.S. WebPatients may be encouraged, but if they look at the side of the moving fingers appropriately, this can be scored as normal. Invest Ophthalmol Vis Sci 2007 Oct;48(10):4445-50. Webunilateral blindness or enucleation, visual fields in the remaining eye are scored. Bilateral lateral compression causes binasal hemianopia (calcified internal carotid arteries). In general, most mass lesions compressing the visual system require surgery both for diagnostic (pathologic confirmation) and therapeutic (relieve mass effect) indications. right. Examining visual field defects in the paedriatric population exposed to vigabatrin. We learned this principle from professor Lou Catania, OD, quoting Hickams dictum: The patient may have as many diseases as he or she pleases.. Double simultaneous stimulation is performed at this point. What Is Quadrantanopia? NovaVision WebThis loss is unilateral and homonymous: this implies that the visual deficit affects the same region of the visual field in both eyes; this is due to the fact that fibers from the nasal hemi-retinas (representing the lateral or temporal visual field) from each eye cross in the optic chiasm, while fibers from the temporal hemi-retina (representing The presence or absence of coincident flashing lights, floaters, dyschromatopsia, eye pain, headache, vertigo, diplopia, metamorphopsia or other seemingly unrelated symptoms will often direct your management. Doc Ophthalmol 2003 Nov;107(3):281-7. A fixed and dilated pupil, ptosis, and a "down-and-out" eye are caused by pressure on the ipsilateral oculomotor nerve. Is there a color vision defect? Optom Vis Sci 2004 May;81(5):298-307. had been recorded at 20/25. One exception to neurology referral is a patient with visual field loss that you suspect is psychogenic in origin. WebUnilateral cortical lesions involving the occipital lobe will usually produce a hemi-field cut contralateral to the site of the lesions. 2. Ed: Rosen ES, Eustace P, Thompson HS, et al. This is considered a bitemporal visual field defect despite the extension into the superior nasal quadrant in the left field. [2], An interesting aspect of quadrantanopia is that there exists a distinct and sharp border between the intact and damaged visual fields, due to an anatomical separation of the quadrants of the visual field. Lesions cause contralateral hemianopia with macular sparing. This includes tighter control of comorbidities such as diabetes, hypertension, hypercholesterolemia, hyperlipidemia and obesity. The retina processes the opposite side of the visual field. Goodwin D. Homonymous hemianopia: challenges and solutions. Effects of pupillary dilation on automated perimetry in normal patients. Barton JJS. Destruction causes transient ipsilateral conjugate deviation of the eyes (i.e., toward the lesion). (CN II) and an efferent limb (CN III). Quadrantanopia - Wikipedia Lesions of the chiasmmost commonly pituitary gland tumors or craniopharyngiomasresult in bitemporal, heteronymous field defects. If there is damage to the optic nerve then complete unilateral anopia can develop. Note that the defect in the right (asymptomatic) eye strongly respects the vertical midline. (5) Ri^ht upper quad* rantanopia. 906-910, Kedar S, Zhang X, Lynn MJ, et al: Pediatric homonymous hemianopia. Its not uncommon during pregnancy and puberty for patients to experience transient scotomas of this sort. The visual pathway from the retina to the visual cortex showing visual field defects. The nystagmus is in the direction of the large arrowhead. In: Neuro-ophthalmology. Light shincd into one eye causes both pupils to constrict. Figure 17-4. The pupillary light pathway. Color vision, visual fields and extraocular motilities were normal in both eyes. This occurs due to a lesion of the ipsilateral optic nerve, causing an optic neuropathy, and of the contralateral decussating inferior nasal retinal fibers, causing loss of the superior and temporal field in the opposite eye. A regular patient to the clinic, he had been seen six months ago for a comprehensive examination and diagnosed with moderate nonproliferative diabetic retinopathy (DR)in both eyes. A referral to a retinologist, neurologist or internist may be required. Knowledge of the functional anatomy of neurological pathways is essential in the interpretation of examination results. Stimulation (e.g., from an irritative lesion) causes contralateral deviation of the eyes (i.e., away from the lesion). It usually affects a Vision was 20/20 O.D. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. WebSudden unilateral quadrantanopia caused by retinal diseases often has characteristic presentations, such as acute onset and severe visual acuity defect. Temporal defect in one eye, central defect inthe fellow eye. Glaucoma is the leading cause of field loss across all adult age groups when tested using automated threshold or supra-threshold perimetry. Compare the afferent anterior pupillary pathway of one eye vs. the fellow eye. Sample visual field* They project from the nasal hemiretina to the contralateral lateral geniculate body and from the temporal hemiretina to the ipsilateral lateral geniculate body. Level Three Stroke Center Acute Stroke Protocol - To be a This complex includes the following structures: 1. Kardon R, Kawasaki A, Miller NR. Although the patients chief complaint seemed to indicate a retinal etiology, testing quickly confirmed this was a neuro-ophthalmic event. For example, I have had patients require a repeat scan because I didnt specify thin enough sections through a particular region. 2006 Nov 25;175(1):18-26. complaints.Causes of Visual Field Loss. Findings of ocular disease will dictate appropriate management strategies based upon the condition. Ultimately, an automated field analysis was performed, demonstrating a dense, homonymous hemianopic defect of the left visual field, denser above than below the horizontal midline. Is there a relative afferent pupillary defect (RAPD)? Neurology 2006; 66: pp. The tips of the occipital cortices are supplied by both the MCA and posterior cerebral artery (PCA). Damage to the optic radiations in the temporal or parietal lobe results in a quadrantanopia, impacting the superior or inferior field, respectively. McKean-Cowdin R, Varma R, Wu J, et al. Frequently seen in females with absent knee or or ankle jerks. 19. This is often from an anterior chiasmal lesion[6]. Superiorquadrantanopia. Visual neglect (also called hemispatial neglect or unilateral NIH Stroke Scale - - RN.org White light comparison testing showed a 25% sensitivity in the left eye as compared to the right. CORTICAL AND SUBCORTICAL CENTERS FOR OCULAR MOTILITY. Homonymous Superior Quadrantanopia Figure 17-5. A trace relative afferent pupillary defect was seen O.S., but both pupils were of normal size. It is caused by lesions of the retrochiasmal J Amer Geriatr Soc 2007 Mar;55(3):357-64. Optic tract CN III Ciliary ganglion CN II. The monocular temporal crescent is represented in the most anterior mesial portion of the occipital lobe. Field defects from damage to the optic nerve tend to be central, asymmetrical and unilateral; visual acuity is A 49-year-old Hispanic male presented with complaints of a red, irritated left eye with significantly reduced vision in the same eye. D. The subcortical center for vertical conjugate gaze is located in the midbrain at the level of the posterior commissure. The upper division (Figure 17-2) projects to the upper bank of the calcarine sulcus, the cuneus. clinical Visual field defects after stroke - Royal Australian Aside from these rare but critical cases, the most important testone that must not be skippedis automated perimetry. 1. When to do Automated Field Testing: On attempted lateral conjugate gaze, the only muscle that functions is the intact lateral rectus. Ophthalmology 2005 Oct;112(10):1821-8. Imaging for neuro-ophthalmic and orbital disease - a review. Consultation with the appropriate medical caregiver is prudent. Mass lesions in parietal lobe produces contralateral inferior homonymous quadrantic field defect also referred as pie on the floor. Quadrantanopia can also result in significant constraints of ones vision and ability to Identification of field loss using screening techniques. American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Functional Genomics and Translational Biology, Council on Hypertension. The cortical visual pathway projects from the primary visual cortex (Brodmann's area 17) to the visual association cortex (Brodmann's area 19). Post-chiasmal lesions result in homonymous field defects, i.e., affecting the same side (right or left) of the visual field and respecting the vertical midline. Another way to help confirm subtle RAPDs is to purchase an inexpensive 0.3 log unit neutral density (ND) filter. Abstract. Unfortunately, during resection of the tumor, the right optic nerve was damaged, and the patient was left with partial visual field loss in both eyes. Also, defects that respect the vertical midline are nearly always located at the chiasm or farther back in the visual pathway. To fully appreciate the potential underlying causes for various visual field defects, it is important to have a working knowledge of the anatomy of the visual system (figure 1). 14. By definition, an incomplete hemianopia spares at least part of the vision on the affected side. Few things provoke more anxiety (for both the patient and the doctor) than noticeable visual field loss. If there is a complete lesion or compression at the optic nerve, patients may experience total monocular vision loss in the affected eye. WebA superior quadrantanopia results from an insult to the optic radiation inferiorly in the temporal lobe, resulting in a pie in the sky type of visual field defect (Figure 1d), while an As a result, the following neurologic defects occur. Effects of dipivefrin and pilocarpine on pupil diameter, automated perimetry and logMAR acuity. These fields are cortical centers for involuntary (smooth) pursuit and tracking movements. 9nNa6>yKEV Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found. Specific visual field deficits can be attributed to the location of compression, which in turn can help clinicians localize lesions based on physical examination and diagnostic testing. Copyright 2023 Jobson Medical Information LLC unless otherwise noted. [1] While quadrantanopia can be caused by lesions in the temporal and parietal lobes of the brain, it Visual fields are below. 2005 Mar 31.;352(13):1305-16. OCT-A Shows Microvascular Glaucomatous Damage, 10-2 Visual Field Testing: A Tool for All Glaucoma Stages, AI-assisted Retinal Screening Shows Promise. Quickly switch the occluder to the normal eye, and shine the light in the abnormal eye. https://doi.org/10.1097/IJG.0b013e3182934978, Takahashi, M., Goseki, T., Ishikawa, H., Hiroyasu, G., Hirasawa, K., & Shoji, N. (2018). Quadrantanopia - Symptoms, Causes, Stroke, Recovery, Treatment Midsagittal transection or pressure (often from a pituitary tumor) causes bitemporal hemianopia. If there is extinction, patient receives a 1, and the results are used to respond to Prevalence and causes of visual field loss in the elderly and associations with impairment in daily functioning: the Rotterdam Study. This presents with loss of both temporal fields and is due to compression of the bilateral II. 2. Bilateral deficits are caused by chiasmal lesions or lesions affecting the retrochiasmal pathways. Recovery from poststroke visual impairment: evidence from a clinical trials resource. and 20/200 O.S. a. Transection causes a contralateral lower quadrantanopia. quadrantanopia, inferior. Transection of the lower division (B) results in right upper homonymous quadrantanopia. A significant visual field defect was present in not only the left eye, consistent with the patients case history, but also in the right eye. Arch Ophthalmol 2001 Dec;119(12):1788-94. If patient is blind from any cause, score 3. complaints. The pretectal nucleus of the midbrain, which projects (through the posterior commissure) crossed and uncrossed fibers to the Edinger-Westphal nucleus. Ultimately, this patient was diagnosed with neurosyphilis, and was treated with penicillin. Scotomas that change can be considered transient, so they are more likely vascular in origin. Vision was 20/30 O.D. Visual field manifestations can be variable within the orbit, depending on the location of compression and the fibers affected. WebRed Eye, Red Herring A 49-year-old Hispanic male presented with complaints of a red, irritated left eye with significantly reduced vision in the same eye. Post-geniculate fibers split into superior and inferior pathways, traveling through the parietal and temporal lobes, respectively, as they course posteriorly in the brain. [3], Homonymous denotes a condition which affects the same portion of the visual field of each eye. His visual acuity recovered fully, but his visual fields only partially recovered. Once confirmed, treatment goals for isolated stroke are aimed at controlling modifiable risk factors that could predispose to subsequent CVAs. History of head trauma. Ophthalmology 2007 Dec;114(12):2232-7. [citation needed]. The patient underwent neuroradiological evaluation, and a craniopharyngioma was found. Otherwise, many of these cases are considered to be urgencies rather than emergencies, and require referral within a few days to a week. These fibers exit the midbrain with CN III and synapse with postganglionic parasympathetic neurons of the ciliary ganglion. 16. The late Larry Gray, OD, used to tell us visual fields read like a roadmap to the brain. The implication is, if you can understand the architecture of the pathways and the nuances of visual field defects, you can potentially pinpoint the precise location of the intracranial pathology. Temporal lobe lesion (infarct, hemorrhagic stroke, trauma) on the side oppositethe visual field defect. Visual Field Defect Webfingers appropriately, this can be scored as normal. Miller, Neil R., Newman, Nancy J. eds. Lam BL, Thompson HS. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. In pre-chiasmal field defects, anopia is unilateral. (9) Left central scotoma as seen in optic (retrobulbar) neuritis in multiple sclerosis. 2. Damage to the left parietal lobe can result in right-left confusion, agraphia and acalculia referred to as Gerstmanns Syndrome. Visual radiation to lingual gyrus Visual radiation to cuneus. An anisocoria produces a small relative afferent pupillary defect in the eye with the smaller pupil. White light comparison testing showed a 25% sensitivity in the left eye as compared to the right. 22. WebUnilateral lesions can lead to homonymous hemianopias and scotomas. neglect Severity of visual field loss and health-related quality of life. Ring scotoma (usually bilateral). 1. Behav Brain Res. Contralateral homonymous superior quadrantanopia often called pie in the sky is seen when a mass lesion is in the temporal lobe. Carefully evaluate the anterior and posterior segments. Vision restorative training (VRT) may provide a mechanism to regain visual function at the border of the visual field defect, although studies with this system have yielded conflicting and inconclusive results. At todays visit, he reported a two-day history of vision loss, which developed abruptly. B. To fully appreciate the potential underlying causes for various visual field defects, it is important to have a working knowledge of the anatomy of the visual system. The underlying diagnosis is often serious and can threaten long-term vision and even the patients well-being. Continue reading here: Tuberoinfundibular Tract, Feminessence: Meditation For Your Feminine Voice, Beat Procrastination for Once and For All, Boost your Bust Natural Breast Enlargement, Candida Crusher Permanent Yeast Infection Solution, Axial Image Through The Thalamus And Internal Capsule, Tongue Deviation Lesion - Cerebral Artery. The amount of compensatory movements and the frequency with which they are employed is believed to be dependent on the cognitive demands of the task; when the task is so difficult that the subject's spatial memory is no longer sufficient to keep track of everything, patients are more likely to employ compensatory behavior of biasing their gaze to the afflicted side. Lesions of the occipital lobe result in homonymous hemianopias, contralateral to the side of the lesion (i.e., a right-sided field defect with a left-sided lesion and vice-versa). Neurorehabil Neural Repair. 2. Score 1 only if a clear-cut asymmetry, including quadrantanopia, is found. Vision was 20/20 O.D. It can be associated with a lesion of an optic radiation. Optic radiation There was a pronounced RAPD in the left eye with reduced color vision (1/14 plates) in the left eye only. (2018). left, O.D. If there is unilateral blindness or enucleation, visual fields in the remaining eye are scored. Figure 17-1. If you find nothing, neuroimaging is essential; place emphasis on the retro-orbital space, the optic nerves, chiasm and optic tracts. The optic nerve projects from the lamina cribrosa of the scleral canal, through the optic canal, to the optic chiasm. FindingsOur patient was found to have an incomplete, moderately congruous, left homonymous hemianopia, denser above than below the horizontal midline. Lesions of the Optic Chiasm, Parasellar Region, and Pituitary Fossa. The cuneus is the upper bank. Slightly more than half the nasal pupil pathway fibers cross at the chiasm, so significant defects anterior to the chiasm cause an RAPD. In Ophthalmology (Fifth Edition, pp. The posterior area receives macular input (central vision). INTRODUCTION. He said he experienced unusual flashes of light, followed by a sudden darkening affecting his left eye. hemorrhagic stroke, trauma)on the side opposite the, AI Algorithms Successful in Diagnosing DR, Peripheral Retinal Lesion Detection Improves With UWF Imaging, Rapid Macular Thinning an Early Sign of HCQ Toxicity. Other localizing signs were CN = cranial nerve. Definition (NCI) Blurred vision is the loss of visual acuity (sharpness of vision) resulting in a loss of ability to see small details. Natural course of visual field loss in patients with type 2 Usher syndrome. If you are not comfortable performing such tests, you can refer this patient to a neurologist for them. b. Transection of both lingual gyri causes an upper altitudinal hemianopia (al-titudinopia). You can enhance the reliability of standard finger-counting testing by adding a facial Amsler test (have the patient fixate on your eyes and ask him or her if your other facial features appear distorted or are missing) and by performing double simultaneous stimulation confrontation fields. Stimulation causes contralateral conjugate deviation of the eyes. 2. 492-507, Posner JB: Intracranial metastases. Complete homonymous hemianopias have no localizing value, except to say that they are post-chiasmal.1. Neuro-Ophthalmology (Amsterdam: Aeolus Press. Chiasmal syndromes. 7. Some authorities place the "center" in the paramedian pontine reticular formation. The incidence of visual field loss increases with age. Often, patients first notice visual symptoms accidentally, even if the problem has been long-standing. The associated features like aphasia and hallucinations will help to further localize lesions to the temporal lobe[13]. Congruity refers to the similarity in shape and depth of the visual field defect in each eye. In: Neuro-ophthalmology. O.S. Premature Ejaculation Causes and Treatment, Anxiety and Panic Disorders Holistic Cure, Electromagnetic Radiation and Human Health, How to Improve Your Sex Life With Your Partner. The use of aspirin as a platelet anti-aggregant may be advisable in those with significant intracranial arterial stenosis.3 Smoking cessation (including avoidance of second-hand smoke), a low-fat diet and regular exercise are also typically encouraged.4, Optometric management depends on the extent of field loss and the degree of recovery following the stroke. Postganglionic sympathetic fibers pass through the tympanic cavity and cavernous sinus and enter the orbit through the superior orbital fissure. The visual association cortex (Brodmann's area 19) projects through the cortico-tectal tract to the superior colliculus and pretectal nucleus. J AAPOS 2006; 10: pp. A Roadmap to the BrainVisual field testing provides insight into the integrity of the visual pathway. 2013 Feb;27(2):133-41. Transection causes contralateral hemianopia. Note that half of the optic nerves cross at the optic chiasm, causing vision loss on one side to be quite different than that in one eye. A Cellulite Cure - How to Get Rid of Cellulite. Kedar S, Zhang X, Lynn MJ, et al. Optic nerve sheath meningioma. The lateral geniculate body receives input from layer VI of the striate cortex (Brodmann's area 17). [4], Homonymous inferior quadrantanopia is a loss of vision in the same lower quadrant of visual field in both eyes whereas a homonymous superior quadrantanopia is a loss of vision in the same upper quadrant of visual field in both eyes. These field defects will cross neither the vertical midline nor the horizontal midline. So macular vision can be spared when only one of the major cerebral vessel distributions is affected. Orbital masses. Ramrattan RS, Wolfs RC, Panda-Jonas S, et al. (4) Right hemianopia. It can be associated with a lesion of an optic radiation. Instructions Scale Definition Score - National Institutes of Health Acute Monocular Quadrantanopia and Retinal Diseases What if there is no ocular cause for the field loss? Nerve fibers originating in the nasal retina cross at the level of the optic chiasm, traveling with contralateral temporal fibers to the lateral geniculate nucleus where they synapse. 1. The visual pathway. Figure 17-3. C. The optic chiasm contains decussating fibers from the two nasal hemiretinas. Patient with MLF syndrome cannot adduct the eye on attempted lateral conjugate gaze, and has nystagmus in abducting eye. Ophthalmology 2008 Jun;115(6):941-48.e1. Although it may present as a complete bitemporal hemianopia, most patients will have an asymmetric presentation on visual field testing[4]. A., & Piva, A. P. (2019). Ask what the patient was doing when he or she first noticed the loss. Nearly one out of every 20 people past age 55 has visual field loss that is significant enough to impair daily functioning. An As the corticospinal motor tracts are often involved as well causing contralateral hemiparesis[13]. 3. This visual defect is caused by damage to superior fibers of the optic radiations. It occurs in syphilis and diabetes. Biomicroscopy revealed healthy anterior segment structures; dilated funduscopy showed moderate nonproliferative DR, but no evidence of neovascular scaffolding, vitreous hemorrhage or retinal detachment in either eye. Optic radiations exit dorsally from the LGN into two separate fascicles: Inferior (known as Meyers loop) and Superior (known as the parietal fascicles). Any other clinical finding (subjective or objective) that does not correlate with other examination findings.In many cases, attention to proper hydration and caloric intake, along with awareness of the effects of postural changes (e.g., standing up quickly from a seated or reclined position) is sufficient for managing the symptoms. Foroozan, R. (2003). Ultimately, this patient was diagnosed with neurosyphilis, and was treated with penicillin. 2. (Convergence is normal.) 1. Convergence remains intact. (Reprinted with permission from Fix JD: BRS Neuroanatomy. Optic tract lesions are relatively uncommon[9], with lateral geniculate nucleus (LGN) lesions being even more rare but when seen, are due to ischemic, demyelinating, or traumatic etiologies. Ask the patient to assign a brightness value of 100 points to that light. However, the nasal retinal fibers decussate to the contralateral side for processing by the contralateral hemisphere of the brain[6]. 18. Besides your normal history and examination sequence, ask: Is the field loss in one eye, or is it on one side of the field? Edgar DF, Crabb DP, Rudnicka AR, et al. A. This page was last edited on 15 February 2023, at 12:25. WebIt can be caused by a lesion, particularly, in the temporal and parietal lobes although it is more commonly associated with occipital lobe lesions. Homonymous hemianopia - UpToDate Retinitis pigmentosa. [21] Causes [ edit] On this Wikipedia the language links are at the top of the page across from the article title. Also important in the localization of visual field defects is the concept of congruity. The etiologies of retrochiasmal lesions are different between adults and children. McKean-Cowdin R, Wang Y, Wu J, et al. Hemianopsia - Wikipedia It projects to the ipsilateral lateral rectus muscle and, through the medial longitudinal fasciculus (MLF), to the contralateral medial rectus subnucleus of the oculomotor complex. Glaucoma is the leading cause of visual field loss across all age groups.1 However, glaucoma patients often dont present with an initial chief complaint of visual field loss, unless the disease is quite advanced. This includes tighter control of comorbidities such as diabetes, hypertension, hypercholesterolemia, hyperlipidemia and obesity. The retrochiasmal afferent pathway extends posteriorly past the chiasm and includes the optic tract, lateral geniculate body, optic radiations, and the striate cortex[8]. WebQuadrantanopia is a condition associated with the temporal and parietal region of brain. Visual field recovery after vision restoration therapy (VRT) is independent of eye movements: an eye tracker study. Transection causes ipsilateral blindness, with no direct pupillary light reflex. For pathology affecting the post-chiasmal pathways, the accepted convention is that greater congruity is associated with more posteriorly located lesions. Bitemporal field loss. It receives input from the contralateral frontal eye field. B. Occipital eye fields are located in Brodmann's areas 18 and 19 of the occipital lobes. The rostral Edinger-Westphal nucleus, which mediates pupillary constriction through the ciliary ganglion. Dalla Via P, Opocher E, Pinello ML, et al. Of course, this test should be interpreted relative to other potential findings, such as corneal edema, cataracts, or other conditions that can affect the patients perception of brightness. Visual Field Defects