A Stroke of Bad Luck: Bilateral Visual Field Loss in a Young Male

Introduction: Lacunar infarcts are small-vessel ischemic strokes that frequently cause lasting neurologic defects, including homonymous visual field loss.

Case Presentation: A 38-year-old male presented with a history of sudden visual distortion followed by a headache. Best-corrected visual acuity was 20/20 in each eye, and ocular health appeared unremarkable. However, confrontation fields and automated visual field testing revealed a highly congruent right inferior homonymous defect. Neuroimaging subsequently confirmed a 7-mm lacunar infarct in the left corpus callosum, along with multiple chronic cerebellar lacunar infarcts. The patient was co-managed by neuro-ophthalmology, neurology, cardiology, and primary care, with treatment initiated for hypertension, hypercholesterolemia, and hypertriglyceridemia.

Discussion: Lacunar strokes account for approximately 20-30% of ischemic events and may present with subtle visual symptoms. This case demonstrates the value of visual field testing in identifying neurologic pathology and localizing lesions affecting the visual pathway. As primary eye care providers, optometrists are often among the first healthcare professionals to detect stroke-related visual complaints. Recognition of ocular manifestations and timely referral can facilitate earlier diagnosis and intervention.

Conclusion: Long-term management of stroke survivors requires close interprofessional collaboration to manage systemic vascular risk factors, reduce the risk of recurrence, and optimize patient quality of life.