title: Absent relative afferent pupillary defect in an asymptomatic case of lateral chiasmal syndrome from cerebral aneurysm.
abstract: BACKGROUND
  This report documents a case of an asymptomatic 34-year-old female who had right eye subtle temporal optic nerve pallor with absent clinically detectable relative afferent pupillary defect.
  
  
  METHODS
  This presentation was secondary to a fusiform paraclinoid aneurysm resulting in lateral chiasmal syndrome. Visual fields demonstrated a nasal depression OD. Neuroimaging studies revealed the presence of a fusiform paraclinoid aneurysm compressing the right optic nerve and optic chiasm. The lesion was treated surgically without additional visual loss nor systemic and neurological complications.
  
  
  CONCLUSIONS
  A clinically detectable relative afferent pupillary defect may be absent in unilateral optic nerve pallor and/or visual field loss and does not preclude the need to attempt to identify an underlying etiology. Neuroradiological examination of orbital and cranial structures is an imperative protocol in the appropriate management of this potential life- and vision-threatening condition.
authors.affiliation: Nova Southeastern University College of Optometry, North Miami Beach, Florida 33162, USA. ebesada@hpd.acast.nova.edu
authors.forename: E
authors.initials: E
authors.lastname: Besada
authors.forename: J P
authors.initials: JP
authors.lastname: Fisher
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D009896:Optic Atrophy / Q000175:diagnosis / Q000209:etiology*; D009897:Optic Chiasm / Q000473:pathology*; D009900:Optic Nerve / Q000002:abnormalities; D011681:Pupil Disorders / Q000175:diagnosis / Q000209:etiology*; D013577:Syndrome; D014786:Vision Disorders / Q000209:etiology*; D014792:Visual Acuity; D014794:Visual Fields