Pituitary and Optic Tract Lesions Masquerading As Glaucoma: Highlighting Diagnostic Challenges

Purpose This study's purpose is to highlight the diagnostic pitfalls in distinguishing glaucomatous optic neuropathy from compressive optic neuropathies caused by intracranial lesions, particularly pituitary macroadenomas. Methodology This research was a retrospective case series of six patients who were originally diagnosed or suspected to have glaucomatous optic neuropathy but later revealed intracranial lesions on neuroimaging. Results All patients had optic disc cupping and/or pallor with visual field defects (VFDs) overlapping with glaucomatous patterns. However, atypical features such as VFDs respecting the vertical meridian, homonymous hemianopia, optic disc pallor disproportionate to cupping, and poor correlation between structure and function raised suspicion for non-glaucomatous causes. Neuroimaging revealed pituitary macroadenoma in four patients, parasellar meningioma in one, and an optic tract lesion in another. Conclusion Compressive optic neuropathies may closely mimic glaucoma, resulting in delayed diagnosis and inappropriate treatment. Careful attention to atypical field patterns and disc findings, combined with timely neuroimaging, is crucial for avoiding irreversible vision loss.