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Amaurosis Fugax – Causes, Symptoms & Treatment

Amaurosis fugax is a sudden, temporary, and painless loss of vision in one eye, lasting seconds to minutes, and is considered an important warning sign of an impending stroke.

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Things worth knowing about "Amaurosis Fugax"

Amaurosis fugax is a sudden, temporary, and painless loss of vision in one eye, lasting seconds to minutes, and is considered an important warning sign of an impending stroke.

What is Amaurosis Fugax?

Amaurosis fugax (Latin: fleeting blindness) is a sudden, short-lived, and painless episode of vision loss or complete blindness in one eye. Episodes typically last only seconds to a few minutes and resolve completely without permanent damage. Medically, this event is classified as a form of transient ischemic attack (TIA) affecting the eye and is considered a serious warning sign that must not be ignored.

Causes

The most common cause of amaurosis fugax is a temporary interruption of blood flow to the retina or optic nerve. The most frequent underlying causes include:

Atherosclerosis: Plaques in the internal carotid artery can break off and temporarily block small blood vessels in the eye.
Embolism: Small blood clots or cholesterol crystals originating from the heart or large vessels can briefly occlude the central retinal artery.
Cardiac conditions: Atrial fibrillation or heart valve disease increases the risk of clot formation that may travel to the eye.
Vasospasm: Spastic narrowing of blood vessels, for example during a migraine attack, can also cause transient vision loss.
Rarer causes: Giant cell arteritis (temporal arteritis), severe hypotension, or blood clotting disorders.

Symptoms

The hallmark symptom of amaurosis fugax is a sudden, complete or partial loss of vision in one eye. Patients often describe the experience as:

A dark curtain or shade descending or ascending over the visual field
A grey haze or blurring restricted to one eye
Complete loss of vision in one eye lasting seconds to minutes

The vision loss is typically painless and affects only one eye. It resolves spontaneously and completely without any intervention. Accompanying symptoms such as dizziness, speech difficulties, or limb weakness may indicate a concurrent stroke.

Diagnosis

Since amaurosis fugax is a warning sign for an impending stroke, immediate medical evaluation is essential. Typical diagnostic steps include:

Ophthalmologic examination: Fundoscopy to assess retinal vessels and detect possible emboli
Carotid artery duplex ultrasound: Detection of stenosis or plaques in the carotid artery
ECG and echocardiography: Ruling out cardiac sources of embolism such as atrial fibrillation
Blood tests: Assessment of coagulation, lipid levels, and inflammatory markers
Brain MRI or CT: Exclusion of an already-occurring stroke

Treatment

Treatment is directed at the underlying cause and aims to prevent stroke or permanent vision loss:

Antiplatelet therapy: Medications such as aspirin (acetylsalicylic acid) or clopidogrel reduce clot formation and lower stroke risk.
Anticoagulation: In cases of atrial fibrillation, blood thinners (e.g., warfarin or novel oral anticoagulants) are prescribed.
Carotid endarterectomy: Surgical removal of plaques from the carotid artery in cases of high-grade stenosis.
Management of vascular risk factors: Control of hypertension, diabetes mellitus, and elevated cholesterol levels.
Treatment of giant cell arteritis: If this inflammatory condition is suspected, high-dose corticosteroids must be started immediately to prevent permanent blindness.

Important: Every episode of amaurosis fugax should be treated as a medical emergency and investigated promptly, as the risk of stroke is significantly elevated in the hours and days following the event.

References

German Neurological Society (DGN) - Guidelines on Transient Ischemic Attack and Stroke, 2023.
Hayreh, S. S. - Ocular Vascular Occlusive Disorders. Springer International Publishing, 2015.
Amarenco P. et al. - Transient Ischemic Attack. New England Journal of Medicine, 2020; 382:1933-1941.

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