Amaurosis fugax

Adrian Marchidann MD (Dr. Marchidann of SUNY Health Science Center has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released April 13, 1995; last updated January 23, 2017; expires January 23, 2020

This article includes discussion of amaurosis fugax, transient visual loss, transient vision loss, transient monocular blindness, and transient monocular visual field loss. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Amaurosis fugax or transient vision loss is a symptom that raises concern for both patients and physicians because it may reflect a wide variety of pathologic processes, some of which may have important neurologic or ophthalmic consequences like stroke or blindness. The author reviews the current literature concerning the potential pathophysiologic mechanisms, diagnostic testing, and treatment strategies. In addition to noninvasive, accurate measurement of carotid artery stenosis, the identification of the vulnerable plaque at risk for rupture and stroke has aroused considerable interest. The section on prevention of stroke in patients with carotid steno-occlusive disease has been expanded to reflect the results of several completed clinical trials.

Key points

 

• Amaurosis fugax is a clinical term, describing the occurrence of transient monocular or binocular visual loss due to retinal artery ischemia.

 

• Vascular causes should be considered because if found, early treatment may reduce the risk of recurrent ischemia in appropriate patients.

 

• Detection of the vulnerable plaque will help better understanding, predict its behavior, and improve the risk stratification of carotid artery stenosis.

 

• Internal carotid and ophthalmic arteries vasospasm and venous abnormalities should be suspected in patients with amaurosis fugax without internal carotid artery atherosclerosis.

 

• Carotid artery endarterectomy should be performed as early as possible to prevent ischemic stroke in patients with significant carotid artery stenosis. The optimal timing is still being debated.

 

• Stenting of symptomatic carotid artery stenosis has gained significant popularity over the past decade and rivals, in experienced hands, with carotid endarterectomy.

 

• New oral anticoagulants have been approved for patients with nonvalvular atrial fibrillation. Their role continues to expand as the results of new trials become available.

Historical note and terminology

Amaurosis fugax refers to the symptom of transient visual loss. Its meaning and application have varied throughout the years, reflecting the diverse group of disorders potentially responsible. In the early 1800s, amaurosis fugax merely referred to loss of sight (Fisher 1989). In the 1830s, the term described fleeting blindness, with no specification regarding laterality or etiology. In the early 1900s, the term “transient monocular blindness” was often used interchangeably with amaurosis fugax. The terms used encompassed a diverse set of symptoms, but only occasionally referred to a specific etiology of visual loss. In the past decade, amaurosis fugax has been defined as transient monocular visual loss, usually of vascular origin.

For the purposes of this review, the working definition of amaurosis fugax will be unilateral or bilateral transient visual loss due to retinal ischemia.

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