2021 Volume 38 Issue 2 Pages 179-183
In his 40s, a male subject presented a case of traumatic chiasmal syndrome（TCS）with hemifield slide phenomenon and complaints of diplopia and photophobia. The patient was diagnosed with bitemporal hemianopia caused by a skull base fracture sustained from blunt frontal region trauma. Four years after the onset, the patient visited our clinic due to experiencing photophobia and diplopia while driving. The visual acuity was 0.6 OD and 1.2 OS. Static and dynamic visual field examination revealed bitemporal hemianopia. Magnetic resonance imaging showed no abnormalities in the pituitary body. Spasms of the anterior communicating artery were considered to cause ischemia of the optic chiasm, resulting in bitemporal hemianopia. As there was exophoria at near position and the absence of significant limitation in ocular motility, we presumed that diplopia was the consequence of a hemifield slide phenomenon caused by fusion deficiency that resulted from bitemporal hemianopia. Moreover, photophobia could have resulted from damage to the suprachiasmatic nucleus. Fusion training and the use of light-shielding glasses improved the symptoms of diplopia and photophobia.
