In patients who present with atypical findings that cannot be explained by the clinical circumstances—for example, unilateral disease, decreased central vision, dyschromatopsia, young age, presence of a relative afferent pupillary defect, neuroretinal rim pallor, or visual field loss inconsistent with optic nerve appearance—additional medical and neurologic evaluation should be considered. This evaluation may include assessment for a compressive etiology, carotid artery insufficiency, anemia, syphilis, certain vitamin deficiencies, giant cell arteritis or other causes of systemic vasculitis, and exposure to a toxic substance. Noninvasive tests of carotid circulation (eg, carotid Doppler ultrasonography) may be helpful. In cases of optic nerve pallor or visual field loss suggestive of a neurologic defect, evaluation of the anterior visual pathway, including the optic chiasm, with magnetic resonance imaging or computed tomography may be warranted. See also BCSC Section 5, Neuro-Ophthalmology.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.