What is homonymous hemianopsia in a patient with a history of neurological or vascular disease, possibly older with conditions such as hypertension, diabetes, or hyperlipidemia?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: January 20, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

What is Homonymous Hemianopsia

Homonymous hemianopsia is a visual field defect characterized by blind spots in the right or left halves of the visual fields of both eyes, resulting from damage to the visual pathways posterior to the optic chiasm. 1

Definition and Anatomical Basis

Homonymous hemianopsia (HH) occurs when there is damage to the suprachiasmatic (retrochiasmal) visual pathways, affecting either the two right or two left halves of the visual field in both eyes. 2, 3 The lesion location can be anywhere along the post-chiasmatic visual pathway, including the optic tract, lateral geniculate nucleus, optic radiations, or occipital cortex. 3

Clinical Presentation and Subtypes

The condition manifests in several forms, with incomplete hemianopsia being more common (62.4%) than complete hemianopsia (37.6%). 3

Common Subtypes Include:

  • Homonymous quadrantanopia (29% of cases) - affecting one quarter of the visual field 1, 3
  • Homonymous scotomatous defects (13.5% of cases) - localized blind spots 3
  • Partial hemianopsia (13% of cases) 3
  • Hemianopsia with macular sparing (7% of cases) 3

Laterality Patterns:

  • Right hemianopsia causes difficulty seeing the end of longer words and impairs the ability to see subsequent words, disrupting normal reading saccade patterns 1
  • Left hemianopsia causes difficulty identifying the beginning of the next line of text 1
  • Right homonymous hemianopsia indicates visual loss in the right visual field and may be associated with left-sided weakness, left-sided sensory loss, left-sided neglect, and abnormal visual-spatial ability 1

Etiology in Neurological and Vascular Disease

In patients with vascular risk factors such as hypertension, diabetes, and hyperlipidemia, stroke is the predominant cause, accounting for 69.6% of all cases. 3

Primary Causes:

  • Stroke (69.6%) - most common etiology 3
  • Traumatic brain injury (13.6%) 3
  • Brain tumors (11.3%) 3
  • Neurosurgical procedures (2.4%) 3
  • Multiple sclerosis and demyelination (1.4%) 2, 3

Lesion Locations:

  • Occipital lobes (45% of cases) - most common location 3
  • Optic radiations (32.2% of cases) 3

A critical caveat: specific visual field defect patterns do not reliably predict specific brain locations, as every type of HH (except unilateral loss of temporal crescent and homonymous sectoranopia) can occur with lesions at any location along the retrochiasmal visual pathways. 3

Functional Impact and Associated Deficits

HH significantly impairs reading performance, visual search and scanning of the environment, safe mobility, and the ability to complete many daily activities. 1

Specific Functional Limitations:

  • Reading difficulties - patients experience decreased accuracy and reading speed due to disrupted saccadic patterns 1
  • Spatial orientation problems - patients stumble, fall, or knock into objects they cannot see 2
  • Visual search disorders - prolonged search duration with increased fixations and refixations (repeated scanning of previously searched locations) 4
  • Driving impairment - frequently precludes driving 3
  • Sudden appearance phenomenon - patients are surprised when people or objects suddenly appear in their visual field 2

Associated Neurological Deficits:

Only 45% of HH cases are isolated visual deficits; the majority have associated neurological impairments. 3 These may include contralateral weakness, sensory loss, aphasia (with left hemisphere lesions), neglect, or monocular blindness (amaurosis fugax) when associated with carotid artery disease. 1

Clinical Recognition and Awareness

Affected individuals may or may not be aware of their visual field deficit, making clinical assessment essential. 1 Patients with acute stroke may have additional factors complicating recognition, including dysphasia (23%), upper-limb motor deficits (77%), or altered consciousness (19%). 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Homonymous hemianopsia.

Klinika oczna, 2012

Related Questions

What are the management strategies for different types of hemianopia?
What is the management and evaluation approach for an adult patient, possibly older, with a history of neurological or vascular disease, presenting with homonymous hemianopsia, and a past medical history that may include conditions such as hypertension, diabetes, or hyperlipidemia?
What is the management approach for a patient with unilateral inferior hemianopsia?
What is the diagnosis and treatment for left hemianopia?
What is homonymous hemianopia and what are its causes?
What are the next steps for a young adult or child with a history of abdominal pain or jaundice and a choledochal cyst visible on Magnetic Resonance Cholangiopancreatography (MRCP) but not found during intraoperative exploration?
What are the causes of hemolysis in patients with various medical histories, including autoimmune disorders and genetic conditions?
What are the criteria for discharging a patient who has been on intravenous antibiotics with ceftriaxone and clindamycin?
Which selective serotonin reuptake inhibitor (SSRI) is most likely causing skin excoriation in a patient taking fluoxetine (Prozac)?
What is the appropriate evaluation and treatment for a female patient presenting with a vaginal odor similar to bacterial vaginosis (BV)?
Does a 0.8 x 0.6 x 0.9 cm chronic lymph node with a fatty hilum in the submandibular region of an adult's right neck, and a normal throat exam with a negative throat swab, warrant a biopsy?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question