The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.

The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

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Unilateral optic atrophy from pituitary tumour

Photo by Professor Chua Chung Nen

A patient presented with a two-year history of poor left vision. Examination revealed normal right vision 6/6 and hand movement left vision. Swinging light reflex revealed left relative afferent pupillary defect and fundoscopy showed severely cupped left optic disc with normal intraocular pressures in both eyes. CT scan showed a pituitary tumour that compressed the left optic nerve near the optic chiasm. Visual field also showed the presence of right visual field defect. He had no signs or symptoms of endocrine disorders indicating that the tumour was non-secretory.

A transnasal resection of the tumor was carried out. The operation was uneventful but the patient developed subarachnoid haemorrhage post-operatively and required intensive care treatment. A cerebral angiogram revealed an aneurysm in the anterior cerebral artery which was believed to be the source of the bleeding. A second operation was performed three days after the initial operation to clip the artery.

 

Figure 1 Severely cupped left optic disc.

 

Figure 2. Increased C/D ratio of the right optic disc.

 

Figure 3. Visual field shows dense left central scotoma. The right eye shows arcuate scotoma.

 

Figure 4. Pituitary tumour with left optic nerve compression.

 

Figure 5. The actual size of the tumour as measured on the CT scan.

 

Figure 6. Coronal view of the pituitary tumour.

 

Figure 4. Subarachnoid haemorrhage post-excision of the pituitary tumour.

 

Figure 8. Left anterior cerebral artery aneurysm.

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