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The varieties of junctional scotoma: 17 cases, a review, and a taxonomy

Eye volume 39, pages 1673–1687 (2025)Cite this article

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Abstract

The hemi-decussation at the optic chiasm creates the potential for crossed and uncrossed fibers to be affected in isolation or in various combinations of nerve, chiasm and tract, with patterns that reflect the retinotopic arrangement of axons. We present seventeen cases that illustrate the field defects that can result and review the literature to create a taxonomy of junctional visual field defects. The complete junction defect is blindness in one eye and loss of the entire temporal field of the other. The classic junctional scotoma combines optic neuropathy in one eye with upper temporal hemifield loss in the other, and is often a sign of ventral compression. The less frequent atypical junctional scotoma involves the lower temporal hemifield and has a higher frequency of dorsal compression or non-compressive pathology. There are the monocular defects in the temporal (‘junctional scotoma of Traquair’) or nasal hemifield, the latter of which is rarely if ever due to a pituitary adenoma. Highly asymmetric bitemporal defects with or without a central scotoma and the paradoxical junctional scotoma occur by extension of the lesion causing the junctional scotoma of Traquair. The posterior junction defect results from combined damage to the optic chiasm and optic tract. Recognizing these various patterns is important clinically as junctional defects have the same localizing significance as bitemporal defects and are being encountered more often. In addition the probability of certain types of pathology varies with the type of junctional defect.

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Fig. 1: Classic junctional scotomata.
Fig. 2: Atypical junctional scotomata.
Fig. 3: Perimetric results (left eye on left) and coronal MRI images of lesions.
Fig. 4: Posterior junction defect.
Fig. 5: Indeterminate or complex syndromes.
Fig. 6: Cartoon of the optic chiasm, with nerves at the top of the figure and the tracts at the bottom, and proposed localization of various junctional defects.

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Acknowledgements

Figures in cases 1, 6 and 12 are adapted with permission from: Barton JJS, Benatar M. Field of Vision: a manual and atlas of perimetry, Humana Press (now Springer Nature), Totowa NJ, 2003, and those of cases 7, 9 and 15 are reproduced with permission from www.neuro-ophthalmology.ca. We thank Briar Sexton for sharing case 9 with us.

Funding

JB was supported by the Marianne Koerner Chair in Brain Diseases and Canada Research Chair 950-232752.

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Authors and Affiliations

  1. Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada

    Jason J. S. Barton & Gülcenur Özturan

  2. Neuro-ophthalmology, Section K, VGH Eye Care Centre, 2550 Willow Street, Vancouver, BC, Canada

    Jason J. S. Barton & Gülcenur Özturan

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  1. Jason J. S. Barton
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  2. Gülcenur Özturan
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JB – Conceptualization, Funding acquisition, Project administration, Writing – original draft, Writing – review and editing. GO- Resources, Data curation, Methodology, Writing – review and editing.

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Correspondence to Jason J. S. Barton.

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Approval for retrospective chart and imaging review was obtained from the institutional review board of the University of British Columbia, UBC CREB number: H24-00975.

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Barton, J.J.S., Özturan, G. The varieties of junctional scotoma: 17 cases, a review, and a taxonomy. Eye 39, 1673–1687 (2025). https://doi.org/10.1038/s41433-025-03789-z

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