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  • Updated 03.31.2022
  • Released 04.13.1995
  • Expires For CME 03.31.2025

Amaurosis fugax

Introduction

Overview

Amaurosis fugax, or transient vision loss, has many causes, some of which may lead to blindness or stroke. The author reviews the current literature concerning the potential pathophysiologic mechanisms, diagnostic testing, and treatment strategies. The section on the 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 vision loss due to retinal artery ischemia.

• Transient retinal ischemia is a medical emergency that requires prompt evaluation and treatment.

• The risk of stroke following amaurosis fugax is lower than after an ischemic stroke.

• Morphology of a vulnerable plaque may better assess the risk of stroke than severity of carotid artery stenosis.

• In the absence of internal carotid artery atherosclerosis, vasospasm of internal carotid and ophthalmic arteries or venous abnormalities may be responsible for amaurosis fugax.

• Revascularization of symptomatic carotid artery stenosis may prevent ischemic stroke; the optimal timing of the procedure is between day 3 and 14 after the ischemic event.

• Stenting and carotid endarterectomy of eligible symptomatic carotid artery stenosis have similar outcomes.

Historical note and terminology

The meaning of amaurosis fugax, or transient visual loss, has evolved throughout the years, reflecting the improved understanding of potentially responsible disorders. In the early 1800s, amaurosis fugax merely referred to loss of sight (27). 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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