Homonymous Hemianopsia

patient with visual fields showing loss of vision in each eye

patient with visual fields showing loss of vision in each eye

Loss of side vision is a frequent problem after brain injury owing to the long course that the nerves must follow from the eyes to the occipital lobe at the back of the brain.  Patients may know something is wrong, but not recognize that their problems may relate to the loss of their side vision. The two human eyes together are capable of 180 degrees or more of visual field. After a brain injury, side vision can be impaired on one half of the visual field, contain sporadic areas of loss or holes in the vision, or be constricted to tunnel vision. Some spontaneous improvement is possible in the first three to six months, but only a small number of patients have full recovery.

The most common problem is a homonymous hemianopsia, a loss of all or part of one half of the field of view in both eyes opposite the side of the brain injury. A patient with a stroke in the left posterior part of the brain may lose the right side of the visual field and may have weakness or paralysis on the right side. The first steps in visual rehabilitation for visual field loss may be with an occupational therapist in the hospital or at a rehabilitation center where they will begin to train you to scan to help compensate for your visual field loss. The next step should be a referral to one of our doctors who may further evaluate ways to help with your vision issues after the TBI.  

Checklist of Problems from a Visual Field Loss such as Hemianopsia 

  • Frequently bumps into objects like doorframes, furniture or people.
  • Difficulty and uneasiness in moving about in crowded areas.
  • Unsure of footing while walking and may trip or stumble.
  • Often startled by moving objects or people appearing suddenly.
  • May have bruises on shoulder or arm from colliding with doorframes.
  • Frequently loses place in reading and becomes frustrated when reading.
  • Struggles to find or misjudges the start or end of a line of print in reading.
  • Has withdrawn from most reading.
  • Frequently spills drinks when eating.
  • Unsteady balance in walking and may report dizziness.
  • Problems in finding things on desks, counter tops, cabinets or closets. 
  • Fear or anxiety in walking through unfamiliar areas.
  • Uneasiness or even panic attacks in crowded area.