Amaurosis Fugax: Symptoms, Causes & What to Do

Definition

Amaurosis fugax (transient monocular vision loss) is a temporary, painless loss of vision in one eye, typically lasting seconds to minutes, caused by transient retinal ischemia.

Typical Symptoms

• Sudden, painless vision loss (curtain/shade descending)
• Blurred or dim vision
• Scintillations, floaters, or streaks
• Complete recovery within minutes (usually <15 min)

Associated Symptoms (if TIA/stroke)

• Hemiparesis, facial droop, dysarthria
• Vertigo, diplopia, ataxia
• Headache, nausea

Common Causes

• Carotid artery atherosclerosis (emboli from plaque)
• Cardiac emboli (AF, valve disease, thrombus)
• Giant cell arteritis (urgent – prevent bilateral blindness)
• Hypercoagulable states
• Vasospasm (migraine equivalent)

Urgent Evaluation

1. Seek emergency care – amaurosis fugax is a transient ischemic attack (TIA) equivalent; stroke risk ~10% at 90 days.
2. Carotid imaging (Duplex US, CTA, MRA).
3. Cardiac workup (ECG, echo, Holter).
4. Bloods: CBC, lipids, glucose, ESR/CRP (if GCA suspected).

Treatment

Antiplatelet (aspirin/clopidogrel), statin, BP control, carotid endarterectomy/stenting if ≥70% stenosis, anticoagulation if cardioembolic. GCA requires immediate high-dose steroids.