Importance of Longitudinal Visual Function Assessments after Orbital Cavernoma Removal

Background: Orbital cavernomas are lesions consisting of blood-filled cavities located at the optic chiasma and retro-chiasmal afferent visual pathways. Treatment of cavernoma is often via surgical excision. Visual prognosis depends upon complete excision of the lesion and the extent of pre-operative visual impairment.

Case report: A 44-year-old Asian female patient attended the Emergency Department of a local hospital due to recurrent headaches, nausea, and rapid vision deterioration for six days. Medical examination revealed a cavernoma at the right optic nerve and optic chiasm, resulting in significant reduction in visual acuities (20/200 to 20/400) with severe visual field loss in both eyes. An immediate surgical operation of right pterional craniotomy and resection of the cavernoma was performed. However, only a small part of her visual field was restored. Four years later, she started treatment with Traditional Chinese Medicine, with the hope of gaining further improvement in her vision.

Conclusions: In this report, we highlight the importance of various tests of visual function, including visual field, visual evoked potential (VEP), contrast sensitivity, and color vision, for the patient at different intervals after surgical operation of the cavernoma. Interpretations of the clinical findings are made. The importance of parallel care from optometric and medical personnel is discussed.