OBJECTIVE: To discuss the difficulties encountered in the diagnosis of concentric narrowing of the visual fields.

CLINICAL FEATURES: A 13-yr-old child was referred to a chiropractic clinic after an ocular examination concerning a 6-month period of minor headaches, which culminated in a more severe attack, during which she had to lie down. Her examination was essentially normal, with the exception of the presence of constricted visual fields when measured to a small stimulus.

INTERVENTION AND OUTCOME: Standard outpatient spinal adjustments were followed by recovery of vision.

DISCUSSION: The recovery of constricted fields of vision with spinal manipulation has now been discussed with greater frequency in the chiropractic literature. The diagnosis of constriction of the visual fields is often the factor that may decide the further management of the patient. In this instance, constriction of the visual fields could easily have been missed, even though clinical examination of the visual fields had been done.

CONCLUSION: Elements in the history and physical examination will suggest when a sensitive assessment of the visual fields may be of benefit to the patient.

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