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A-Z Glossary

Table of Contents

Tunnel Vision

Courtney Dryer, OD
Written byCourtney Dryer, OD
Courtney Dryer, OD
Courtney Dryer, ODOptometristCharlotte, NC

Bio

Dr. Courtney Dryer earned her doctorate from Southern College of Optometry, Memphis, Tennessee in 2011. She opened her own practice Autarchic Spec Shop in 2013 in Charlotte, NC. She has had the privilege of writing for numerous optometric publications and serving in various industry capacities. In 2015, Vision Monday named her a rising star and one of the most influential women in optometry. Her optometric passions include practice management, specialty contact lenses, and dry eye management.

  • Last updated January 13, 2023

What is a Tunnel Vision?

Tunnel vision refers to a loss of one’s peripheral (side) vision. Tunnel vision is a symptom of an eye disease or neurological condition. Tunnel vision can be permanent or temporary. A temporary cause of tunnel vision may be visual aura with or without a presenting migraine.  Permanent causes may include glaucoma, retinitis pigmentosa, retinal detachments, laser scars to treat diabetic retinopathy, or a stroke.

Key Takeaways

  • Tunnel vision refers to loss of one’s peripheral vision.
  • Damage to the brain or eyes can result in tunnel vision.
  • Tunnel vision may be temporary or permanent. 
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Understanding Tunnel Vision

Tunnel vision is the loss of an individual’s peripheral vision leaving only their central area of vision. One will still be able to view things directly in front of them, just not on the sides. Common things that cause tunnel vision include the following. 

Visual Aura

Migraine auras are transient neurological symptoms, which usually last for 5 to 30 minutes before the onset of migraine pain. It is possible to have visual aura without a migraine headache. Visual aura is the most common aura (approximately 90%) with variable manifestations. Studies estimate 8% of the population has visual auras. A typical visual aura may begin as a flickering, unilateral, uncolored squiggly line. It may start in the center with gradual spread toward the periphery. The progression of visual aura across the visual field is slow, i.e., >4 minutes and gradually returns to normalcy within 20 minutes to an hour.

Glaucoma

Glaucoma is neurodegeneration of the optic nerve and loss in retinal ganglion cells. Glaucoma is the leading cause of irreversible blindness. Glaucoma results in a slow, painless, loss of one’s peripheral vision and in the end stage, results in tunnel vision.  Disease progression can be delayed with diagnosis and effective treatment to reduce the intraocular pressure of the eye. 

Retinitis Pigmentosa (RP)

Retinitis Pigmentosa is an inherited disease which results in progressive peripheral vision loss. RP is estimated to affect 1 in every 4000 people in the United States, and approximately one in 5000 worldwide. RP the most common inherited disease of the retina. It typically presents in both eyes with the symptom of nyctalopia or loss of night vision, followed by narrowing of the visual field. Intraocular eye findings include the “classic triad” of bony spicule pigmentation, vascular narrowing, and the abnormal pallor of the optic disc.

Pan-Retinal Photocoagulation (PRP)

 Pan retinal photocoagulation (PRP) is an effective treatment to decrease the risk of severe vision loss in patients with proliferative diabetic retinopathy. The procedure involves the creation of thermal burns in the peripheral retina leading to tissue coagulation to improve oxygenation to the retina. While effective, there are also concerns that PRP can result in choroidal effusions, exudative retinal detachments, macular edema, visual field deficits, and night vision defects. Depending on the size of the area treated, the procedure may also result in tunnel vision.

Stroke

The eye is an extension of the brain; therefore, vision is often affected by a stroke. The location in the brain where the stroke occurs may result in a decrease in one’s peripheral vision. Tunnel vision is a result of a bilateral stroke affecting both halves of the visual field, with a macular (central) island of vision.  Approximately 20% of stroke sufferers will have a permanent visual field deficit.

Risk Factors for Tunnel Vision

A history of visual aura or other eye conditions like glaucoma are risk factors for tunnel vision. 

Tunnel Vision Symptoms

Tunnel vision is a symptom of a retinal or neurological condition, and is the loss of an individual’s peripheral vision. One will still be able to view things directly in front of them, just not on the sides.

Diagnosing Tunnel Vision

Temporary tunnel vision may not appear on testing, but permanent tunnel vision can be diagnosed from visual field testing.  Visual field testing is also called perimetry and uses light levels to detect a patient’s sensitivity at different locations of the visual field. Neuroimaging may be ordered if a stroke is suspected.

Tunnel Vision Treatment

Treatment depends on the cause for the tunnel vision. It is important to diagnose a condition like glaucoma before it progresses to the point of tunnel vision. A comprehensive eye exam followed by additional testing such as a visual field and OCT are used to confirm diagnosis and determine if current treatment is effective.

Bibliography

  1. Michel F, Henaff MA. Seeing without the occipito-parietal cortex: Simultagnosia as a shrinkage of the attentional visual field. Behav Neurol. 2004;15(1-2):3-13. doi: 10.1155/2004/836830. PMID: 15201489; PMCID: PMC5488620.
  2. O’Neal TB, Luther EE. Retinitis Pigmentosa. 2021 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30137803.
  3. Prager AJ, Kang JM, Tanna AP. Advances in perimetry for glaucoma. Curr Opin Ophthalmol. 2021 Mar 1;32(2):92-97. doi: 10.1097/ICU.0000000000000735. PMID: 33443958.
  4. Novavision. Vision Loss as a Warning Sign of a Stroke. Retrieved September 30, 2022 from https://novavision.com/vision-loss-as-a-warning-sign-of-stroke/
  5. Reddy SV, Husain D. Panretinal Photocoagulation: A Review of Complications. Semin Ophthalmol. 2018;33(1):83-88. doi: 10.1080/08820538.2017.1353820. Epub 2017 Nov 27. PMID: 29172937.
  6. Royle P, Mistry H, Auguste P, et al. Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation. Southampton (UK): NIHR Journals Library; 2015 Jul. (Health Technology Assessment, No. 19.51.) Scientific summary.
  7. Sharif NA. Glaucomatous optic neuropathy treatment options: the promise of novel therapeutics, techniques and tools to help preserve vision. Neural Regen Res. 2018 Jul;13(7):1145-1150. doi: 10.4103/1673-5374.235017. PMID: 30028313; PMCID: PMC6065230.
  8. Singla M; Sulena 2, Kale R, Brar J, Bhardwaj S. Visual Aura in Migraine: An Analysis of 165 Patients in a Tertiary Care Hospital in North India. J Neurosci Rural Pract. 2021 Apr;12(2):273-280. doi: 10.1055/s-0040-1721624. Epub 2021 Mar 3. PMID: 33927518; PMCID: PMC8064847.

Related Terms

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Episclera

is a fibroelastic structure consisting of two layers joined together loosely. It is the white of the eye

Dermatochalasis

describes the presence of loose and redundant eyelid skin. It is most often caused by aging

Chemosis

is the swelling of the conjunctiva, which is the clear membrane over the eyelids and the surface of the eye

Pupillometer

is a device that measures the distance between the pupils. The device is used when you order new eyeglasses

Spatial Frequency

describes the rate that a stimulus changes across space. It is usually measured with black and white line gratings

Macula Lutea

also known as the macula, refers to the small area in the back of the eye that is responsible for central vision

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