Amaurosis fugax (Greek ''

amaurosis Amaurosis (Greek meaning ''darkening'', ''dark'', or ''obscure'') is vision loss or weakness that occurs without an apparent lesion affecting the eye. It may result from either a medical condition or excess acceleration, as in flight. The term is t ...

'' meaning ''darkening'', ''dark'', or ''obscure'', Latin '' fugax'' meaning ''fleeting'') is a painless temporary loss of vision in one or both eyes.

Signs and symptoms

The experience of amaurosis fugax is classically described as a temporary loss of vision in one or both eyes that appears as a "black

curtain A curtain is a piece of cloth or other material intended to block or obscure light, air drafts, or (in the case of a shower curtain), water. A curtain is also the movable screen or drape in a theatre that separates the stage from the auditorium ...

coming down vertically into the

field of vision The visual field is the "spatial array of visual sensations available to observation in introspectionist psychological experiments". Or simply, visual field can be defined as the entire area that can be seen when an eye is fixed straight at a point ...

in one eye;" however, this altitudinal visual loss is relatively uncommon. In one study, only 23.8 percent of patients with transient monocular vision loss experienced the classic "curtain" or "shade" descending over their vision.{{{cite journal , vauthors = ((North American Symptomatic Carotid Endarterectomy Trial Collaborators)), ((Barnett HJM)), Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, Fox AJ, Rankin RN, Hachinski VC, Wiebers DO, Eliasziw M , title = Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis , journal = N Engl J Med , volume = 325 , issue = 7 , pages = 445–53 , date = August 1991 , pmid = 1852179 , doi = 10.1056/NEJM199108153250701 Other descriptions of this experience include a monocular blindness, dimming, fogging, or blurring.{{cite journal , vauthors = Lord RS , title = Transient monocular blindness , journal = Aust N Z J Ophthalmol , volume = 18 , issue = 3 , pages = 299–305 , date = August 1990 , pmid = 2261177 , doi = 10.1111/j.1442-9071.1990.tb00624.x Total or sectorial

vision loss Visual impairment, also known as vision impairment, is a medical definition primarily measured based on an individual's better eye visual acuity; in the absence of treatment such as correctable eyewear, assistive devices, and medical treatment� ...

typically lasts only a few seconds, but may last minutes or even hours. Duration depends on the cause of the vision loss. Obscured vision due to papilledema may last only seconds, while a severely atherosclerotic carotid artery may be associated with a duration of one to ten minutes.{{cite journal , vauthors = Donders RC, ((Dutch Tmb Study Group)), title = Clinical features of transient monocular blindness and the likelihood of atherosclerotic lesions of the internal carotid artery , journal = J Neurol Neurosurg Psychiatry , volume = 71 , issue = 2 , pages = 247–9 , date = August 2001 , pmid = 11459904 , pmc = 1737502 , doi = 10.1136/jnnp.71.2.247 Certainly, additional symptoms may be present with the amaurosis fugax, and those findings will depend on the cause of the transient monocular vision loss.{{citation needed, date=December 2020

Cause

Prior to 1990, amaurosis fugax could, "clinically, be divided into four identifiable symptom complexes, each with its underlying pathoetiology: embolic, hypoperfusion, angiospasm, and unknown".{{cite journal , vauthors = Burde RM , title = Amaurosis fugax. An overview , journal = J Clin Neuroophthalmol , volume = 9 , issue = 3 , pages = 185–9 , date = September 1989 , pmid = 2529279 In 1990, the causes of amaurosis fugax were better refined by the Amaurosis Fugax Study Group, which has defined five distinct classes of transient monocular blindness based on their supposed cause: embolic, hemodynamic, ocular, neurologic, and idiopathic (or "no cause identified").{{cite journal , vauthors = ((The Amaurosis Fugax Study Group)), title = Current management of amaurosis fugax. The Amaurosis Fugax Study Group , journal = Stroke , volume = 21 , issue = 2 , pages = 201–8 , date = February 1990 , pmid = 2406992 , doi = 10.1161/01.str.21.2.201 , doi-access=free Concerning the pathology underlying these causes (except

idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent wikt:spontaneous, spontaneous origin. From Ancient Greek, Greek ἴδιος ''idios'' "one's own" and πάθος ''pathos'' "suffering", ''idiopathy'' means approxi ...

), "some of the more frequent causes include atheromatous disease of the internal carotid or ophthalmic artery, vasospasm, optic neuropathies, giant cell arteritis, angle-closure glaucoma, increased intracranial pressure, orbital compressive disease, a steal phenomenon, and blood hyperviscosity or hypercoagulability."{{cite book , vauthors = Newman NJ , chapter=Cerebrovascular disease , veditors = Hoyt WG, Miller N, Walsh F, Newman NJ, title=Walsh and Hoyt's Clinical Neuro-Ophthalmology , publisher=Williams & Wilkins , location=Baltimore , year=1998 , pages=3420–6 , isbn=0-683-30232-9 , volume=3 , edition=5th

Embolic and hemodynamic origin

With respect to embolic and hemodynamic causes, this transient monocular visual loss ultimately occurs due to a temporary reduction in

retinal artery The central retinal artery (retinal artery) branches off the ophthalmic artery, running inferior to the optic nerve within its dural sheath to the eyeball. Structure The central retinal artery pierces the eyeball close to the optic nerve, sendin ...

ophthalmic artery The ophthalmic artery (OA) is an artery of the head. It is the first branch of the internal carotid artery distal to the cavernous sinus. Branches of the ophthalmic artery supply all the structures in the orbit around the eye, as well as some st ...

, or ciliary artery blood flow, leading to a decrease in retinal circulation which, in turn, causes retinal hypoxia.{{cite journal , vauthors=Jehn A, Frank Dettwiler B, Fleischhauer J, Sturzenegger M, Mojon DS , title=Exercise-induced vasospastic amaurosis fugax , journal=Arch. Ophthalmol. , volume=120 , issue=2 , pages=220–2 , date=February 2002 , pmid=11831932 , url= https://jamanetwork.com/journals/jamaophthalmology/fullarticle/269443 , access-date=2007-03-26 , archive-url=https://web.archive.org/web/20070929133329/http://archopht.ama-assn.org/cgi/content/extract/120/2/220 , archive-date=2007-09-29 , url-status=live While, most commonly, emboli causing amaurosis fugax are described as coming from an atherosclerotic

carotid artery Carotid artery may refer to: * Common carotid artery, often "carotids" or "carotid", an artery on each side of the neck which divides into the external carotid artery and internal carotid artery * External carotid artery, an artery on each side of t ...

, any emboli arising from vasculature preceding the

, or

ciliary arteries The ciliary arteries are divisible into three groups, the long posterior, short posterior, and the anterior. * The short posterior ciliary arteries from six to twelve in number, arise from the ophthalmic artery as it crosses the optic nerve. * The ...

may cause this transient monocular blindness.{{citation needed, date=December 2021 * Atherosclerotic

: Amaurosis fugax may present as a type of

transient ischemic attack A transient ischemic attack (TIA), commonly known as a mini-stroke, is a minor stroke whose noticeable symptoms usually end in less than an hour. TIA causes the same Symptoms of stroke, symptoms associated with strokes, such as weakness or numbn ...

(TIA), during which an

embolus An embolus (; plural emboli; from the Greek ἔμβολος "wedge", "plug") is an unattached mass that travels through the bloodstream and is capable of creating blockages. When an embolus occludes a blood vessel, it is called an embolism or emb ...

unilaterally obstructs the lumen of the

, causing a decrease in blood flow to the ipsilateral retina. The most common source of these athero-emboli is an atherosclerotic carotid artery.{{cite journal , vauthors=Braat A, Hoogland PH, DeVries AC, de Mol VanOtterloo JC , title=Amaurosis Fugax and Stenosis of the Ophthalmic Artery , journal=Vasc Endovascular Surg , volume=35 , issue=2 , pages=141–2 , year=2001 , doi=10.1177/153857440103500210 , pmid=11668383 , s2cid=38943888
However, a severely atherosclerotic

may also cause amaurosis fugax due to its

stenosis A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' ...

of blood flow, leading to ischemia when the retina is exposed to bright light.{{cite journal , vauthors= Kaiboriboon K, Piriyawat P, Selhorst JB , title=Light-induced amaurosis fugax , journal=Am. J. Ophthalmol. , volume=131 , issue=5 , pages=674–6 , date=May 2001 , pmid=11336956 , doi=10.1016/S0002-9394(00)00874-6 "Unilateral visual loss in bright light may indicate ipsilateral carotid artery occlusive disease and may reflect the inability of borderline circulation to sustain the increased retinal metabolic activity associated with exposure to bright light."{{cite journal , vauthors=Furlan AJ, Whisnant JP, Kearns TP , title=Unilateral visual loss in bright light. An unusual symptom of carotid artery occlusive disease , journal=Arch. Neurol. , volume=36 , issue=11 , pages=675–6 , date= November 1979 , pmid=508123 , doi=10.1001/archneur.1979.00500470045007 * Atherosclerotic

: Will present similarly to an atherosclerotic internal carotid artery.{{citation needed, date=December 2021 * Cardiac

emboli An embolism is the lodging of an embolus, a blockage-causing piece of material, inside a blood vessel. The embolus may be a blood clot (thrombus), a fat globule ( fat embolism), a bubble of air or other gas (gas embolism), amniotic fluid ( amni ...

: Thrombotic emboli arising from the heart may also cause luminal obstruction of the retinal, ophthalmic, and/or ciliary arteries, causing decreased blood flow to the ipsilateral retina; examples being those arising due to (1) atrial fibrillation, (2) valvular abnormalities including post-rheumatic valvular disease, mitral valve prolapse, and a bicuspid aortic valve, and (3) atrial myxomas.{{citation needed, date=December 2021 * Temporary

vasospasm Vasospasm refers to a condition in which an arterial spasm leads to vasoconstriction. This can lead to tissue ischemia and tissue death (necrosis). Cerebral vasospasm may arise in the context of subarachnoid hemorrhage. Symptomatic vasospasm or ...

leading to decreased blood flow can be a cause of amaurosis fugax.{{cite journal , vauthors =Fisher M , title=Transient monocular blindness associated with hemiplegia , journal=Arch. Ophthalmol. , volume=47 , issue=2 , pages=167–203 , year=1952 , pmid = 14894017 , doi=10.1001/archopht.1952.01700030174005{{cite journal , vauthors=Ellenberger C, Epstein AD , title=Ocular complications of atherosclerosis: what do they mean? , journal=Semin Neurol , volume=6 , issue=2 , pages=185–93 , date=June 1986 , pmid=3332423 , doi=10.1055/s-2008-1041462 Generally, these episodes are brief, lasting no longer than five minutes,{{cite journal , doi=10.1056/NEJM199109193251207 , vauthors=Burger SK, Saul RF, Selhorst JB, Thurston SE , title=Transient monocular blindness caused by vasospasm , journal=N. Engl. J. Med. , volume=325 , issue=12 , pages=870–3 , date=September 1991 , pmid=1875972 and have been associated with exercise.{{cite journal , vauthors=Imes RK, Hoyt WF , title=Exercise-induced transient visual events in young healthy adults , journal=J Clin Neuroophthalmol , volume=9 , pages=178–80 , year=1989 , pmid=2529277 , issue=3 These vasospastic episodes are not restricted to young and healthy individuals. "Observations suggest that a systemic hemodynamic challenge provoke the release of vasospastic substance in the retinal vasculature of one eye." *

Giant cell arteritis Giant cell arteritis (GCA), also called temporal arteritis, is an inflammatory autoimmune disease of large blood vessels. Symptoms may include headache, pain over the temples, flu-like symptoms, double vision, and difficulty opening the mouth. ...

: Giant cell arteritis can result in granulomatous inflammation within the central retinal artery and posterior ciliary arteries of eye, resulting in partial or complete occlusion, leading to decreased blood flow manifesting as amaurosis fugax. Commonly, amaurosis fugax caused by giant cell arteritis may be associated with jaw claudication and headache. However, it is also not uncommon for these patients to have no other symptoms.{{cite journal , vauthors=Hayreh SS, Podhajsky PA, Zimmerman B , title=Occult giant cell arteritis: ocular manifestations , journal=Am. J. Ophthalmol. , volume=125 , issue=4 , pages=521–6 , date=April 1998 , pmid=9559738 , doi=10.1016/S0002-9394(99)80193-7 One comprehensive review found a two to nineteen percent incidence of amaurosis fugax among these patients.{{cite journal , vauthors =Goodman BW , title=Temporal arteritis , journal=Am. J. Med. , volume=67 , issue=5 , pages=839–52 , date=November 1979 , pmid=389046 , doi=10.1016/0002-9343(79)90744-7 *

Systemic lupus erythematosus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...

{{cite journal , vauthors=Giorgi D, David V, Afeltra A, Gabrieli CB , title=Transient visual symptoms in systemic lupus erythematosus and antiphospholipid syndrome , journal=Ocul. Immunol. Inflamm. , volume=9 , issue=1 , pages=49–57 , date=March 2001 , pmid=11262668 , doi=10.1076/ocii.9.1.49.3980 , s2cid=35161683 {{cite journal , vauthors=Gold D, Feiner L, Henkind P , title=Retinal arterial occlusive disease in systemic lupus erythematosus , journal=Arch. Ophthalmol. , volume=95 , issue=9 , pages=1580–5 , date=September 1977 , pmid=901267 , doi=10.1001/archopht.1977.04450090102008 *

Periarteritis nodosa Polyarteritis nodosa (PAN) is a systemic necrotizing inflammation of blood vessels (vasculitis) affecting medium-sized muscular arteries, typically involving the arteries of the kidneys and other internal organs but generally sparing the lungs' ...

{{cite journal , vauthors=Newman NM, Hoyt WF, Spencer WH , title=Macula-sparing monocular blackouts. Clinical and pathologic investigations of intermittent choroidal vascular insufficiency in a case of periarteritis nodosa , journal=Arch. Ophthalmol. , volume=91 , issue=5 , pages=367–70 , date=May 1974 , pmid=4150748 , doi=10.1001/archopht.1974.03900060379006 *

Eosinophilic Eosinophilic (Greek suffix -phil-, meaning ''loves eosin'') is the staining of tissues, cells, or organelles after they have been washed with eosin, a dye. Eosin is an acidic dye for staining cell cytoplasm, collagen, and muscle fibers. ''Eosi ...

vasculitis Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily caused b ...

{{cite journal , vauthors=Schwartz ND, So YT, Hollander H, Allen S, Fye KH , title=Eosinophilic vasculitis leading to amaurosis fugax in a patient with acquired immunodeficiency syndrome , journal=Arch. Intern. Med. , volume=146 , pages=2059–60 , year=1986 , doi=10.1001/archinte.146.10.2059 , pmid=3767551 , issue=10 *

Hyperviscosity syndrome Hyperviscosity syndrome is a group of symptoms triggered by an increase in the viscosity of the blood. Symptoms of high blood viscosity include spontaneous bleeding from mucous membranes, visual disturbances due to retinopathy, and neurologic sympt ...

Polycythemia Polycythemia (also known as polycythaemia) is a laboratory finding in which the hematocrit (the volume percentage of red blood cells in the blood) and/or hemoglobin concentration are increased in the blood. Polycythemia is sometimes called erythr ...

{{cite journal , vauthors=Berdel WE, Theiss W, Fink U, Rastetter J , title=Peripheral arterial occlusion and amaurosis fugax as the first manifestation of polycythemia vera. A case report , journal=Blut , volume=48 , issue=3 , pages=177–80 , date=March 1984 , pmid=6697006 , doi=10.1007/BF00320341 , s2cid=13588599 *

Hypercoagulability Thrombophilia (sometimes called hypercoagulability or a prothrombotic state) is an abnormality of blood coagulation that increases the risk of thrombosis (blood clots in blood vessels). Such abnormalities can be identified in 50% of people who ...

{{cite journal , vauthors=Mundall J, Quintero P, Von Kaulla KN, Harmon R, Austin J , title=Transient monocular blindness and increased platelet aggregability treated with aspirin. A case report , journal=Neurology , volume=22 , issue=3 , pages=280–5 , date=March 1972 , pmid=5062262 , doi=10.1212/wnl.22.3.280, s2cid=552116 **

Protein C deficiency Protein C deficiency is a rare genetic trait that predisposes to thrombotic disease. It was first described in 1981. The disease belongs to a group of genetic disorders known as thrombophilias. Protein C deficiency is associated with an increased ...

{{cite journal , vauthors=Smith DB, Ens GE , title=Protein C deficiency: a cause of amaurosis fugax? , journal=J. Neurol. Neurosurg. Psychiatry , volume=50 , issue=3 , pages=361–2 , date=March 1987 , pmid=3559620 , pmc=1031809 , doi=10.1136/jnnp.50.3.361 **

Antiphospholipid antibodies Antiphospholipid syndrome, or antiphospholipid antibody syndrome (APS or APLS), is an autoimmune, hypercoagulable state caused by antiphospholipid antibodies. APS provokes blood clots (thrombosis) in both arteries and veins as well as pregnancy-r ...

{{cite journal , vauthors=Digre KB, Durcan FJ, Branch DW, Jacobson DM, Varner MW, Baringer JR , title=Amaurosis fugax associated with antiphospholipid antibodies , journal=Annals of Neurology , volume=25 , issue=3 , pages=228–32 , date=March 1989 , pmid=2729913 , doi=10.1002/ana.410250304 , s2cid=28110036 ***

Anticardiolipin antibodies Anti-cardiolipin antibodies (ACA) are antibodies often directed against cardiolipin and found in several diseases, including syphilis, antiphospholipid syndrome, livedoid vasculitis, vertebrobasilar insufficiency, Behçet's syndrome, idiopathic ...

***

Lupus anticoagulant Lupus anticoagulant is an immunoglobulin that binds to phospholipids and proteins associated with the cell membrane. Its name is a partial misnomer, as it is actually a prothrombotic antibody ''in vivo''. Lupus anticoagulant in living systems cause ...

{{cite journal , vauthors=Landi G, Calloni MV, Grazia Sabbadini M, Mannuccio Mannucci P, Candelise L , title=Recurrent ischemic attacks in two young adults with lupus anticoagulant , journal=Stroke , volume=14 , issue=3 , pages=377–9 , year=1983 , pmid=6419415 , doi=10.1161/01.STR.14.3.377 , doi-access=free {{cite journal , vauthors=Elias M, Eldor A , title=Thromboembolism in patients with the 'lupus'-type circulating anticoagulant , journal=Arch. Intern. Med. , volume=144 , issue=3 , pages=510–5 , date=March 1984 , pmid=6367679 , doi=10.1001/archinte.144.3.510 *

Thrombocytosis Thrombocythemia is a condition of high platelet (thrombocyte) count in the blood. Normal count is in the range of 150x109 to 450x109 platelets per liter of blood, but investigation is typically only considered if the upper limit exceeds 750x109/L. ...

Subclavian steal syndrome In general, Subclavian means beneath the clavicle, and it may refer to: * Subclavian vein * Subclavian artery In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from t ...

Malignant hypertension A hypertensive emergency is very high blood pressure with potentially life-threatening symptoms and signs of acute damage to one or more organ systems (especially brain, eyes, heart, aorta, or kidneys). It is different from a hypertensive urgency ...

can cause ischemia of the optic nerve head leading to transient monocular visual loss.{{cite journal , vauthors=Hayreh SS, Servais GE, Virdi PS , title=Fundus lesions in malignant hypertension. V. Hypertensive optic neuropathy , journal=Ophthalmology , volume=93 , issue=1 , pages=74–87 , date=January 1986 , pmid=3951818 , doi=10.1016/s0161-6420(86)33773-4 * Drug abuse-related intravascular emboli *

Iatrogenic Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 2 ...

: Amaurosis fugax can present as a complication following

carotid endarterectomy Carotid endarterectomy is a surgery, surgical procedure used to reduce the risk of stroke from carotid artery stenosis (narrowing the internal carotid artery). In endarterectomy, the surgeon opens the artery and removes the plaque. The plaque for ...

, carotid

angiography Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is performe ...

cardiac catheterization Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. A common example of cardiac catheterization is coronary catheterization that ...

, and

cardiac bypass Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest p ...

Ocular origin

Ocular causes include: *

Iritis Uveitis () is inflammation of the uvea, the pigmented layer of the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and ...

{{cite journal , doi=10.1111/j.1755-3768.1983.tb04348.x , vauthors =Sørensen PN , title=Amaurosis fugax. A unselected material , journal=Acta Ophthalmol (Copenh) , volume=61 , issue=4 , pages=583–8 , date=August 1983 , pmid=6637419 , s2cid =221395995 *

Keratitis Keratitis is a condition in which the eye's cornea, the clear dome on the front surface of the eye, becomes inflamed. The condition is often marked by moderate to intense pain and usually involves any of the following symptoms: pain, impaired e ...

{{cite journal , vauthors = Bacigalupi M , title=Amaurosis Fugax-A Clinical Review , journal=The Internet Journal of Allied Health Sciences and Practice , volume=4 , issue=2 , pages=1–6 , date=April 2006 , url=http://ijahsp.nova.edu/articles/vol4num2/Bacigalupi.pdf *

Blepharitis Blepharitis is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign objects ...

Optic disc drusen Optic disc drusen (ODD) are globules of mucoproteins and mucopolysaccharides that progressively calcify in the optic disc.Golnik, K. (2006). Congenital anomalies and acquired abnormalities of the optic nerve, (Version 14.3). UptoDate (On-Line Seri ...

Posterior vitreous detachment A posterior vitreous detachment (PVD) is a condition of the eye in which the vitreous membrane separates from the retina. It refers to the separation of the posterior hyaloid membrane from the retina anywhere posterior to the vitreous base (a 3 ...

Closed-angle glaucoma Glaucoma is a group of eye diseases that result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for aqueous humor, fluid withi ...

{{cite journal , vauthors=Ravits J, Seybold ME , title=Transient monocular visual loss from narrow-angle glaucoma , journal=Arch. Neurol. , volume=41 , issue=9 , pages=991–3 , date=September 1984 , pmid=6477235 , doi=10.1001/archneur.1984.04050200097026 * Transient elevation of intraocular pressure * Intraocular

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

Coloboma A coloboma (from the Greek , meaning defect) is a hole in one of the structures of the eye, such as the iris, retina, choroid, or optic disc. The hole is present from birth and can be caused when a gap called the choroid fissure, which is pres ...

Myopia Near-sightedness, also known as myopia and short-sightedness, is an eye disease where light focuses in front of, instead of on, the retina. As a result, distant objects appear blurry while close objects appear normal. Other symptoms may include ...

* Orbital

hemangioma A hemangioma or haemangioma is a usually benign vascular tumor derived from blood vessel cell types. The most common form, seen in infants, is an infantile hemangioma, known colloquially as a "strawberry mark", most commonly presenting on the ski ...

{{cite journal , vauthors=Brown GC, Shields JA , title=Amaurosis fugax secondary to presumed cavernous hemangioma of the orbit , journal=Ann Ophthalmol , volume=13 , issue=10 , pages=1205–9 , date=October 1981 , pmid=7316347 * Orbital

osteoma An osteoma (plural: "osteomata") is a new piece of bone usually growing on another piece of bone, typically the skull. It is a benign tumor. When the bone tumor grows on other bone it is known as "homoplastic osteoma"; when it grows on other tissu ...

{{cite journal , vauthors=Wilkes SR, Trautmann JC, DeSanto LW, Campbell RJ , title=Osteoma: an unusual cause of amaurosis fugax , journal=Mayo Clin. Proc. , volume=54 , issue=4 , pages=258–60 , date=April 1979 , pmid=423606 *

Keratoconjunctivitis sicca Dry eye syndrome (DES), also known as keratoconjunctivitis sicca (KCS), is the condition of having dry eyes. Other associated symptoms include irritation, redness, discharge, and easily fatigued eyes. Blurred vision may also occur. Symptoms range ...

testing

Neurologic origin

Neurological causes include: *

Optic neuritis Optic neuritis describes any condition that causes inflammation of the optic nerve; it may be associated with demyelinating diseases, or infectious or inflammatory processes. It is also known as optic papillitis (when the head of the optic nerv ...

* Compressive optic neuropathies{{cite book , vauthors = Corbett JW, Digre KB , title=Practical viewing of the optic disc , publisher=Butterworth-Heinemann , location=Oxford , year=2003 , pages=269–344 , isbn=0-7506-7289-7 , chapter=Amaurosis Fugax and Not So Fugax—Vascular Disorders of the Eye , chapter-url=http://intl.elsevierhealth.com/e-books/pdf/783.pdf *

Papilledema Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare. In ...

: "The underlying mechanism for visual obscurations in all of these patients appear to be transient ischemia of the optic nerve head consequent to increased tissue pressure. Axonal swelling, intraneural masses, and increased influx of

interstitial fluid In cell biology, extracellular fluid (ECF) denotes all body fluid outside the cells of any multicellular organism. Total body water in healthy adults is about 60% (range 45 to 75%) of total body weight; women and the obese typically have a lower ...

may all contribute to increases in tissue pressure in the optic nerve head. The consequent reduction in perfusion pressure renders the small, low-pressure vessels that supply the optic nerve head vulnerable to compromise. Brief fluctuations in intracranial or systemic blood pressure may then result in transient loss of function in the eyes."{{cite journal , vauthors=Sadun AA, Currie JN, Lessell S , title=Transient visual obscurations with elevated optic discs , journal=Annals of Neurology , volume=16 , issue=4 , pages=489–94 , date=October 1984 , pmid=6497356 , doi=10.1002/ana.410160410 , s2cid=2245543 Generally, this transient visual loss is also associated with a headache and optic disk swelling. *

Multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...

can cause amaurosis fugax due to a unilateral conduction block, which is a result of demyelination and inflammation of the optic nerve, and "...possibly by defects in synaptic transmission and putative circulating blocking factors."{{cite journal , vauthors=Smith KJ, McDonald WI , author2-link=W. Ian McDonald , title=The pathophysiology of multiple sclerosis: the mechanisms underlying the production of symptoms and the natural history of the disease , journal=Philosophical Transactions of the Royal Society B , volume=354 , issue=1390 , pages=1649–73 , date=October 1999 , pmid=10603618 , pmc=1692682 , doi=10.1098/rstb.1999.0510 *

Migraine Migraine (, ) is a common neurological disorder characterized by recurrent headaches. Typically, the associated headache affects one side of the head, is pulsating in nature, may be moderate to severe in intensity, and could last from a few hou ...

{{cite journal , vauthors = Mattsson P, Lundberg PO , title = Characteristics and prevalence of transient visual disturbances indicative of migraine visual aura , journal = Cephalalgia , volume = 19 , issue = 5 , pages = 479–84 , date = June 1999 , pmid = 10403062 , doi = 10.1046/j.1468-2982.1999.019005479.x , s2cid=5961275 {{cite journal , vauthors=Cologno D, Torelli P, Manzoni GC , title=Transient visual disturbances during migraine without aura attacks , journal=Headache , volume=42 , issue=9 , pages=930–3 , date=October 2002 , pmid=12390623 , doi=10.1046/j.1526-4610.2002.02216.x, s2cid=32304894 {{cite journal , vauthors = Connor RC , title=Complicated migraine. A study of permanent neurological and visual defects caused by migraine , journal=Lancet , volume=2 , issue=7265 , pages=1072–5 , date=November 1962 , pmid=14022628 , doi=10.1016/s0140-6736(62)90782-1{{cite journal , vauthors =Carroll D , title=Retinal migraine , journal=Headache , volume=10 , issue=1 , pages=9–13 , date=April 1970 , pmid=5444866 , doi=10.1111/j.1526-4610.1970.hed1001009.x , s2cid=46246035 {{cite journal , vauthors=McDonald WI, Sanders MD , title=Migraine complicated by ischaemic papillopathy , journal=Lancet , volume=2 , issue=7723 , pages=521–3 , date=September 1971 , pmid=4105666 , doi=10.1016/s0140-6736(71)90440-5{{cite journal , vauthors=Wolter JR, Burchfield WJ , title=Ocular migraine in a young man resulting in unilateral transient blindness and retinal edema , journal=Pediatr Ophthalmol. , volume=8 , pages=173–6 , year=1971 {{cite journal , vauthors=Kline LB, Kelly CL , title=Ocular migraine in a patient with cluster headaches , journal=Headache , volume=20 , issue=5 , pages=253–7 , date=September 1980 , pmid=7451120 , doi=10.1111/j.1526-4610.1980.hed2005253.x , s2cid=29684052 {{cite journal , author =Corbett JJ. , title=Neuro-ophthalmologic complications of migraine and cluster headaches , journal=Neurol. Clin. , volume=1 , issue=4 , pages=973–95 , year=1983 , pmid = 6390159 , doi=10.1016/S0733-8619(18)31134-4 * Idiopathic Intracranial Hypertension * Intracranial tumor{{cite journal , author=Hedges TR , title=The terminology of transient visual loss due to vascular insufficiency , journal=Stroke , volume=15 , issue=5 , pages=907–8 , year=1984 , pmid=6474546 , doi=10.1161/01.STR.15.5.907 , s2cid=8664120 , doi-access=free *

Psychogenic A psychogenic effect is one that originates from the brain instead of other physical organs (i.e. the cause is psychological rather than physiological) and may refer to: *Psychogenic pain *Psychogenic disease *Psychogenic amnesia *Psychogenic cou ...

Diagnosis

Despite the temporary nature of the vision loss, those experiencing amaurosis fugax are usually advised to consult a

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

immediately as it is a

symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showin ...

that may herald serious vascular events, including

stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...

.{{cite journal , vauthors=Benavente O, Eliasziw M, Streifler JY, Fox AJ, Barnett HJ, Meldrum H , title=Prognosis after transient monocular blindness associated with carotid-artery stenosis , journal=N. Engl. J. Med. , volume=345 , issue=15 , pages=1084–90 , date=October 2001 , pmid=11596587 , doi=10.1056/NEJMoa002994{{cite journal , vauthors=Rothwell PM, Warlow CP , title=Timing of TIAs preceding stroke: time window for prevention is very short , journal=Neurology , volume=64 , issue=5 , pages=817–20 , date=March 2005 , pmid=15753415 , doi=10.1212/01.WNL.0000152985.32732.EE , s2cid=19550244 Restated, "because of the brief interval between the transient event and a stroke or blindness from temporal arteritis, the workup for transient monocular blindness should be undertaken without delay." If the patient has no history of giant cell arteritis, the probability of vision preservation is high; however, the chance of a stroke reaches that for a hemispheric TIA. Therefore, investigation of cardiac disease is justified. A diagnostic evaluation should begin with the patient's history, followed by a physical exam, with particular importance being paid to the ophthalmic examination with regards to signs of ocular ischemia. When investigating amaurosis fugax, an ophthalmologic consultation is absolutely warranted if available. Several concomitant laboratory tests should also be ordered to investigate some of the more common, systemic causes listed above, including a complete blood count, erythrocyte sedimentation rate, lipid panel, and blood glucose level. If a particular cause is suspected based on the history and physical, additional relevant labs should be ordered. If laboratory tests are abnormal, a systemic disease process is likely, and, if the ophthalmologic examination is abnormal, ocular disease is likely. However, in the event that both of these routes of investigation yield normal findings or an inadequate explanation, noninvasive duplex ultrasound studies are recommended to identify carotid artery disease. Most episodes of amaurosis fugax are the result of stenosis of the ipsilateral carotid artery.{{cite journal , vauthors=Smit RL, Baarsma GS, Koudstaal PJ , title=The source of embolism in amaurosis fugax and retinal artery occlusion , journal=Int Ophthalmol , volume=18 , issue=2 , pages=83–6 , year=1994 , pmid=7814205 , url=http://www.iovs.org/cgi/reprint/1/1/136.pdf , doi=10.1007/BF00919244, s2cid=394747 With that being the case, researchers investigated how best to evaluate these episodes of vision loss, and concluded that for patients ranging from 36 to 74 years old, "...carotid artery duplex scanning should be performed...as this investigation is more likely to provide useful information than an extensive cardiac screening (ECG, Holter 24-hour monitoring, and precordial echocardiography)." Additionally, concomitant head CT or MRI imaging is also recommended to investigate the presence of a "clinically silent cerebral embolism." If the results of the ultrasound and intracranial imaging are normal, "renewed diagnostic efforts may be made," during which

fluorescein angiography Fluorescein angiography (FA), fluorescent angiography (FAG), or fundus fluorescein angiography (FFA) is a technique for examining the circulation of the retina and choroid (parts of the fundus) using a fluorescent dye and a specialized camera. S ...

is an appropriate consideration. However, carotid angiography is not advisable in the presence of a normal ultrasound and CT.{{cite journal , vauthors=Walsh J, Markowitz I, Kerstein MD , title=Carotid endarterectomy for amaurosis fugax without angiography , journal=Am. J. Surg. , volume=152 , issue=2 , pages=172–4 , date=August 1986 , pmid=3526933 , doi=10.1016/0002-9610(86)90236-9

Treatment

Fleeting loss of vision does not in itself require any treatment, but it may indicate an underlying condition, sometimes serious, that must be treated. If the diagnostic workup reveals a systemic disease process, directed therapies to treat the underlying cause are required. If the amaurosis fugax is caused by an atherosclerotic lesion, use of

aspirin Aspirin, also known as acetylsalicylic acid (ASA), is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and/or inflammation, and as an antithrombotic. Specific inflammatory conditions which aspirin is used to treat inc ...

as an

anticoagulant Anticoagulants, commonly known as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time. Some of them occur naturally in blood-eating animals such as leeches and mosquitoes, where the ...

is indicated, and a

considered based on the location and grade of the stenosis. Generally, if the carotid artery is still patent, the greater the stenosis, the greater the indication for endarterectomy. "Amaurosis fugax appears to be a particularly favorable indication for carotid endarterectomy. Left untreated, this event carries a high risk of stroke; after carotid endarterectomy, which has a low operative risk, there is a very low postoperative stroke rate."{{cite journal , vauthors=Bernstein EF, Dilley RB , title=Late results after carotid endarterectomy for amaurosis fugax , journal=J. Vasc. Surg. , volume=6 , issue=4 , pages=333–40 , date=October 1987 , pmid=3656582 , doi=10.1016/0741-5214(87)90003-6 However, the rate of subsequent stroke after amaurosis is significantly less than after a hemispheric TIA, therefore there remains debate as to the precise indications for which a carotid endarterectomy should be performed. If the full diagnostic workup is completely normal, patient observation is recommended.

References

{{Reflist

External links

{{Medical resources , DiseasesDB = 501 , ICD10 = {{ICD10, G, 45, 3, g, 40 , ICD9 = {{ICD9, 362.34 , ICDO = , OMIM = , MedlinePlus = 000784 , eMedicineSubj = neuro , eMedicineTopic = 480 , MeshID = D020757 {{Eye pathology {{Cerebrovascular diseases, state=expanded Stroke Eye diseases Episodic and paroxysmal disorders Symptoms