A scotoma is a localised area of missing or reduced vision within the visual field. It may affect central, paracentral, or peripheral areas.
Causes
Macular disease, optic nerve damage, retinal vascular occlusion, and inflammatory lesions can all produce scotomata. Neurological conditions, including stroke or demyelinating disease, may also create field defects perceived as blank or grey patches.
- Central scotomata typically arise from macular or optic nerve pathology
- Paracentral scotomata can indicate early glaucoma or retinal vascular changes
- Transient scotomata may occur in migraine aura or transient ischemic attacks
- Patients may notice difficulty reading or missing parts of objects
Assessment
Formal visual field testing and structural imaging help localise and diagnose the cause. Urgency depends on onset speed and associated symptoms.
- Sudden scotoma with neurological signs needs emergency evaluation
- Chronic stable scotomata may be monitored and managed with visual aids
- Glaucoma‑related scotomata require long‑term pressure control
- Documentation over time tracks progression or response to treatment
