Amaurosis fugax

Adrian Marchidann MD (

Dr. Marchidann of SUNY Stony Brook University Hospital has no relevant financial relationships to disclose.

)
Steven R Levine MD, editor. (

Dr. Levine of the SUNY Health Science Center at Brooklyn has no relevant financial relationships to disclose.

)
Originally released April 13, 1995; last updated March 10, 2019; expires March 10, 2022

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 may be caused by a wide variety of pathologic processes, some of which may lead to 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 transient monocular or binocular visual loss due to retinal artery ischemia.

 

• Amaurosis fugax is associated with lower risk for recurrent stroke than stroke.

 

• There are many causes of retinal ischemia that may require timely treatment.

 

• Detection of a vulnerable plaque helps assess the risk 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.

 

• Significant carotid artery stenosis may benefit from revascularization and prevent ischemic stroke. The optimal timing is still being debated.

 

• Stenting of symptomatic carotid artery stenosis rivals, in experienced hands, with carotid endarterectomy.

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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