Amaurosis Fugax

Transient and painless loss of vision in one eye.

Background

  • Common clinical symptom of transient retinal ischaemia.
  • It can have a number of aetiologies but most commonly are cardiovascular.

Aetiology

  • Embolic
    • Carotid bifurcation thromboembolism
    • Cardiac emboli (e.g. mural, valvular)
    • Drug abuse-related vascular emboli
  • Haemodynamic
    • Atherosclerosis
    • Inflammatory arteritides
    • Hypoperfusion (e.g. cardiac failure, systemic diseases affected blood viscosity)
  • Ocular
    • Central retinal vein/artery occlusion
    • Retinal haemorrhage

Presentation

  • Rapid onset of unilateral visual loss (10-15 seconds)
    • ‘Window-curtain’ development i.e. like a curtain being pulled over their eye
    • Lasting seconds-minutes
    • Clears slowly in the reverse direction from lost
  • It is important to evaluate for signs of TIA/stroke as well, e.g. hemiplegia/weakness, because patients will often be at risk of these events too.

Investigations

  • FBC, ESR/PV may be done; may also want to do clotting/INR; ?lipid profile
  • Fluorescein angiography may help identify ophthalmic pathology

Management

  • If thromboembolic, consider low-dose aspirin +/- statin

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