Puzzling Visual Field Loss in Patients with Primary Empty Sella

Several patterns of visual field loss including bitemporal or binasal defects have been sporadically reported in empty sella syndrome (ESS). The authors present automated and Goldmann perimetry findings in three female patients (age range 54-64 years) with ESS, normal intraocular pressure, good visual acuity, and non-glaucomatous cupping of the optic disc. Irregular bilateral peripheral constriction with normal appearance of the optic disc were found in the first patient. The second patient showed a moderately pale disc with an inferonasal defect in her right eye, and a pale disc with only a central and partially temporal field remaining in her left eye. The third patient had irregular constriction of the visual field and a pale disc in her right eye, and a normal field in her left eye; both optic discs were slightly elevated and increased intracranial pressure was recorded. No noteworthy progression of perimetric defects was found after a six-year follow-up. Understanding the cause of visual field defects similar to those found in these patients may be challenging, and should prompt adequate neuro-imaging focusing on possible ESS.