Occipital tip injury with homonymous central scotoma: OCT-NFL and RGC correlation

Purpose: To report one case of homonymous paracentral scotoma with corresponding optical coherence tomography (OCT) findings in a young woman after injury to the left occipital lobe tip. Observations: A young woman with past medical history of Hodgkin's lymphoma and large B-cell lymphoma metastatic to the left occipital lobe status post resection presented to the eye clinic with a chief complaint of a “blind spot” in the right eye since her surgery. Humphrey visual field (HVF) showed a right homonymous paracentral scotoma corresponding to the non-decussating and decussating optic radiation for central vision originating from the left lateral geniculate nucleus (LGN). OCT confirmed atrophy of the right nasal hemifovea with fibers originating from the papillomacular bundle and the left temporal hemifovea with fibers originating from the superior temporal segment of the optic nerve. These fibers correspond to the central vision involved with the left posterior occipital lobe tip. Conclusions and Importance: We report a case of right homonymous central vision loss as a result of injury to the left posterior occipital lobe tip with certain unique features. Here, a small lesion in the posterior visual pathway led to a relatively large loss of ganglion cell layer. Keywords: Ganglion cell layer, Nerve fiber layer, Homonymous hemianopia, Thinning