Received: 22 January  2019; Published: 28 November 2019 

Neuro-opthalmological aspect of chiasmal-and-sellar disorders

V.A. Vasyuta,1 Dr Sc (Med); Yu.E. Pedachenko,2 Dr Sc (Med), Ass Prof

1 Romodanov Neurosurgery Institute, National Academy of Medical Science of Ukraine; Kyiv (Ukraine)

2  Neurosurgery Department, Shupik National Medical Academy of Postgraduate Education;  Kyiv (Ukraine)

E-mail:  Vasyuta.v@ukr.net

This article reviews the causes, pathogenesis, and major manifestations of chiasmal syndrome. In addition, it reviews the methods for diagnosing the condition, and the course of the syndrome in patients with various chiasmal-and-sellar disorders such as pituitary adenoma, craniopharyngioma, tuberculum sellae meningioma, and skull base aneurysm. The principle neuro-ophthalmological symptoms include decreased visual acuity, bitemporal visual field defects, and development of descending optic nerve atrophy. Early detection of ophthalmological symptoms is of critical importance for timely neurosurgical treatment.

Keywords: chiasm, visual acuity, visual field, optic nerve


  1. Mejico LJ, Miller NR, Dong LM. Clinical features associated with lesions other than pituitary adenoma in patients with an optic chiasmal syndrome. Am J Ophthalmol.  2004 May;137(5):908-13.
  2. Miller NR, Newman NJ, Biousse V, Kerrison JB, editors. Walsh & Hoyt's clinical neuro-ophthalmology: the essentials. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
  3. Wadud SA, Ahmed S, Choudhury N, Chowdhury D. Evaluation of ophthalmic manifestations in patients with intracranial tumours. Mymensingh Med J. 2014 Apr;23(2):268-71.
  4. Blieden L, Foroozan R. Disorders of the optic chiasm. Expert Rev Ophthlmol. 2009 Dec;4(6):649-50.
  5. Amini A, Digre K, Couldwell WT. Photophobia in a blind patient: An alternate visual pathway. Case report. J Neurosurg. 2006 Nov;105(5):765-8. 
  6. Astorga-Carballo A, Serna-Ojeda JC, Camargo-Suarez MF. Chiasmal syndrome: Clinical characteristics in patients attending an ophthalmological center. Saudi J Ophthal. 2017 Oct-Dec; 31(4): 229–33.
  7. Hagihara N, Abe T, Yoshioka F. Photophobia as the visual manifestation of chiasmal compression by unruptured anterior communicating artery aneurysm. Case report. Neurol Med Chir (Tokyo). 2009 Apr;49(4):159-61.
  8. Kawasaki A, Purvin VA. Photophobia as the presenting visual symptom of chiasmal compression. J Neuroophthalmol. 2002 Mar;22(1):3-8.
  9. Foroozan R. Chiasmal syndromes. Curr Opin Ophthalmol. 2003 Dec;14(6):325-31.
  10. Vellayan Mookan L, Thomas PA, Harwani AA. Traumatic chiasmal syndrome: A meta-analysis. Am J Ophthalmol Case Rep. 2018 Jan 11;9:119-123. doi: 10.1016/j.ajoc.2018.01.029.
  11. Schiefer U, Isbert M, Mikolaschek E, et al. Distribution of scotoma pattern related to chiasmal lesions with special reference to anterior junction syndrome. Graefes Arch Clin Exp Ophthalmol. 2004 Jun;242(6):468-77.
  12. Zhong Y, Shen X, Min Y, et al. The role of blue-on-yellow perimetry in patients with pituitary tumor. Ann Ophthalmol (Skokie). 2009 Spring;41(1):40-3.
  13. Johansson C, Lindblom B. The role of optical coherence tomography in the detection of pituitary adenoma.  Acta Ophthalmol. 2009 Nov;87(7):776-9. doi: 10.1111/j.1755-3768.2008.01344.x.
  14. Tieger MG, Hedges TR 3rd, Ho J, et al.  Ganglion Cell Complex Loss in Chiasmal Compression by Brain Tumors. J Neuroophthalmol. 2017 Mar;37(1):7-12. doi: 10.1097/WNO.0000000000000424.
  15. Menjot de Champfleur N, Menjot de Champfleur S, Galanaud D, et al. Imaging of the optic chiasm and retrochiasmal visual pathways. Diagn Interv Imaging. 2013 Oct;94(10):957-71. doi: 10.1016/j.diii.2013.06.012.
  16. Ogra S, Nichols AD, Stylli S, et al. Visual acuity and pattern of visual field loss at presentation in pituitary adenoma. J Clin Neurosci. 2014 May;21(5):735-40. doi: 10.1016/j.jocn.2014.01.005.
  17. 17. Sowka JW, Luong B.  Bitemporal visual field defects mimicking chiasmal compression in eyes with tilted disc syndrome. Optometry. 2009 May;80(5):232-42. doi: 10.1016/j.optm.2008.11.005.
  18. Trevino R. Chiasmal syndrome.  J Am Optom Assoc. 1995 Sep;66(9):559-75.
  19. Sousa RM, Oyamada MK, Cunha LP, Monteiro MLR. Multifocal Visual Evoked Potential in Eyes With Temporal Hemianopia From Chiasmal Compression: Correlation With Standard Automated Perimetry and OCT Findings. Invest Ophthal Vis Sci. 2017 Sep 1;58(11):4436-4449. doi: 10.1167/iovs.17-21529.
  20. Glisson CC. Visual loss due to optic chiasm and retrochiasmal visual pathway lesion. Continuum (Minneap Minn). 2014 Aug;20(4 Neuro-ophthalmology):907-21. doi: 10.1212/01.CON.0000453312.37143.d2.
  21. Masaya-anon P, Lorpattanakasem J.  Intracranial tumors affecting visual system: 5-year review in Prasat Neurological Institute. J Med Assoc Thai. 2008 Apr;91(4):515-9.
  22. Rojas D, Palma A, Wohllk N. [Management of pituitary adenomas]. Rev Chil Neuro-psiquiatr. 2008;46(2): 140–7. Spanish.
  23. Jacob M, Raverot G, Jouanneau E, et al. Predicting visual outcome after treatment of pituitary adenomas with optical coherence tomography. Am J Ophthalmol. 2009 Jan;147(1):64-70.e2. doi: 10.1016/j.ajo.2008.07.016.
  24. Baglin G, Betermiez P, Bertout A, et al. [Pituitary apoplexy and severe bilateral visual loss: a case report]. J Fr Ophthalmol. 2009 Oct;32(8):572-6. French. doi: 10.1016/j.jfo.2009.04.019.
  25. Foroozan R. Visual Findings in Chiasmal Syndromes. Int Ophthalmol Clin. 2016 Winter;56(1):1-27. doi: 10.1097/IIO.0000000000000097.
  26. Reyes KB, Goh KY, Gullen JF. Glare in a Case of a Craniopharyngioma. Neuroophthalmology. 2011 Mar 20;35(2):73-75. doi: 10.3109/01658107.2011.557761.
  27. Viswanathan A, Demonte F. Tumors of the meninges. Handb Clin Neurol. 2012;105:641-56. doi: 10.1016/B978-0-444-53502-3.00014-8.
  28. Singh DK, Behari S, Jaiswal AK, et al. Pediatric anterior visual pathway gliomas: trends in fluid and electrolyte dynamics and their management nuances. Childs Nerv Syst. 2015 Mar;31(3):359-71. doi: 10.1007/s00381-014-2606-1.
  29. Kim J, Nam TK, Park KS. An Unruptured Anterior Communicating Artery Aneurysm Presenting with Left Homonymous Hemianopsia: A Case Report. J Cerebrovas Endovas Neurosurg. 2017 Jun;19(2):92-95. doi: 10.7461/jcen.2017.19.2.92.
  30. Tsutsumi S, Ono H, Yasumoto Y.Vascular Compression of the Anterior Optic Pathway: A Rare Occurrence? Can Assoc Radiol J. 2017 Nov;68(4):409-413. doi: 10.1016/j.carj.2017.02.001.
  31. Kawasaki A, Purvin VA. Idiopathic chiasmal neuritis: clinical features and prognosis. Arch Ophthalmol. 2009 Jan;127(1):76-81. doi: 10.1001/archophthalmol.2008.516.
  32. Danesh-Meyer HV, Wong A, Papchenko T, et al. Optical coherence tomography predict visual outcome for pituitary tumors. J Clin Neurosci. 2015 Jul;22(7):1098-104. doi: 10.1016/j.jocn.2015.02.001. 
  33. Loo JL, Tian J, Miller NR, Subramanian PS. Use of optical coherence tomography in predicting post-treatment visual outcome in anterior visual pathway meningiomas // Br J Ophthalmol. 2013 Nov;97(11):1455-8. doi: 10.1136/bjophthalmol-2013-303449.