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Amaurosis fugax

  • Definition
    • Amaurosis fugax is a temporary loss of vision in one or both eyes due to a lack of blood flow to the retina. The retina is the light-sensitive layer of tissue at the back of the eyeball.

  • Alternative Names
    • Transient monocular blindness; Transient monocular visual loss; TMLV; Transient monocular visual loss; Transient binocular visual loss; TBVL; Temporary visual loss - amaurosis fugax

  • Causes
    • Amaurosis fugax is not itself a disease. Instead, it is a sign of other disorders. Amaurosis fugax can occur from different causes. One cause is when a blood clot or a piece of plaque blocks an artery in the eye. The blood clot or plaque usually travels from a larger artery, such as the carotid artery in the neck or an artery in the heart, to an artery in the eye.

      Plaque is a hard substance that forms when fat, cholesterol, and other substances build up in the walls of arteries. Risk factors include:

      • Heart disease, especially irregular heartbeat
      • Alcohol abuse
      • Cocaine use
      • Diabetes
      • Family history of stroke
      • High blood pressure
      • High cholesterol
      • Increasing age
      • Smoking (people who smoke one pack a day double their risk of a stroke)

      Amaurosis fugax can also occur because of other disorders such as:

      • Other eye problems, such as inflammation of the optic nerve (optic neuritis)
      • Blood vessel disease called polyarteritis nodosa
      • Migraine headaches
      • Brain tumor
      • Head injury
      • Multiple sclerosis (MS), inflammation of the nerves due to the body's immune cells attacking the nervous system
      • Systemic lupus erythematosus, an autoimmune disease in which the body's immune cells attack healthy tissue throughout the body
  • Symptoms
    • Symptoms include the sudden loss of vision in one or both eyes. This usually lasts for a few seconds to several minutes. Afterward, vision returns to normal. Some people describe the loss of vision as a gray or black shade coming down over the eye.

  • Exams and Tests
    • The health care provider will perform a complete eye and nervous system exam. In some cases, an eye exam will reveal a bright spot where the clot is blocking the retinal artery.

      Tests that may be done include:

  • Treatment
    • Treatment of amaurosis fugax depends on its cause. When amaurosis fugax is due to a blood clot or plaque, the concern is to prevent a stroke. The following can help prevent a stroke:

      • Avoid fatty foods and follow a healthy, low-fat diet. DO NOT drink more than 1 to 2 alcoholic drinks a day.
      • Exercise regularly: 30 minutes a day if you are not overweight; 60 to 90 minutes a day if you are overweight.
      • Quit smoking.
      • Most people should aim for a blood pressure below 120 to 130/80 mm Hg. If you have diabetes or have had a stroke, your doctor may tell you to aim for a lower blood pressure.
      • If you have diabetes, heart disease, or hardening of the arteries, your LDL "bad" cholesterol should be lower than 70 mg/dL.
      • Follow your doctor's treatment plans if you have high blood pressure, diabetes, high cholesterol, or heart disease.

      Your doctor may also recommend:

      • No treatment. You may only need regular visits to check the health of your heart and carotid arteries.
      • Aspirin, warfarin (Coumadin), or other blood-thinning drugs to lower your risk of stroke.

      If a large part of the carotid artery appears blocked, carotid endarterectomy surgery is done to remove the blockage. The decision to do surgery is also based on your overall health.

  • Outlook (Prognosis)
    • Amaurosis fugax increases your risk of stroke.

  • When to Contact a Medical Professional
    • Call your provider if any vision loss occurs. If symptoms last longer than a few minutes or if there are other symptoms with the vision loss, seek medical attention right away.

  • References
    • Bagheri N, Mehta S. Acute vision loss. Prim Care. 2015;42(3):347-361. PMID: 26319342 www.ncbi.nlm.nih.gov/pubmed/26319342.

      Biller J, Ruland S, Schneck MJ. Ischemic cerebrovascular disease. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 65.

      Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754-3832. PMID: 25355838 www.ncbi.nlm.nih.gov/pubmed/25355838.

      Quiros PA, Hedges TR. Vascular disorders. In: Yanoff M, Duker JS, eds. Ophthalmology. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 9.26.