Amaurosis fugax

Overview

Amaurosis fugax is a temporary loss of vision in one eye that usually lasts from a few seconds to a few minutes. It often feels like a curtain or shade is coming down over your vision. It is a warning sign that something may be blocking blood flow to your eye, and it can mean you are at risk of a stroke.

It is not common, but it is an important warning sign that should not be ignored.

It most often affects older adults, especially those with conditions like high blood pressure, diabetes, or high cholesterol. It can also affect younger people who have heart or blood vessel problems.

Symptoms

Common symptoms

• Sudden, painless vision loss in one eye
• Feeling like a dark curtain or shade is coming down over your vision
• Vision returning on its own within minutes, usually less than 30 minutes

Symptoms in children

• Symptoms are the same: sudden vision loss in one eye that returns
• In children, the cause may be different, such as a heart condition
• It is also a medical emergency in children

Symptoms in older adults

• Same symptoms as adults
• Older adults are more likely to have underlying conditions like narrowed carotid arteries or atrial fibrillation

Causes

Main causes

• A small blood clot or piece of plaque (fatty deposit) traveling from the carotid artery to the eye
• Narrowing of the carotid artery (carotid artery disease)
• Heart conditions that can produce blood clots, such as atrial fibrillation
• Inflammation of blood vessels (vasculitis)

Risk factors

• High blood pressure
• High cholesterol
• Diabetes
• Smoking
• Older age
• Heart disease, especially atrial fibrillation
• Previous stroke or transient ischemic attack (TIA)

When to see a doctor

See a doctor urgently if:

• If you have any episode of temporary vision loss in one eye, even if it goes away, you should be seen the same day or go to an emergency department
• If your vision loss does not go away within a few minutes, call emergency services immediately

Book a routine appointment if:

• If you have been diagnosed with amaurosis fugax and are following up with your specialist
• If you have risk factors and want to discuss prevention with your doctor

Diagnosis

Your doctor will ask you about your episode and symptoms, listen to the blood flow in your neck with a stethoscope, and perform a physical exam. They may also test your blood pressure and heart rate.

Tests that may be done

• Carotid ultrasound to check for narrowing or blockage in the carotid artery
• Echocardiogram to look at your heart for clots or valve problems
• Blood tests to check for diabetes, high cholesterol, and other conditions
• Occasionally a CT or MRI scan of the brain or blood vessels

What to expect at your appointment

You may be referred to a specialist such as a neurologist (brain doctor) or a vascular surgeon (blood vessel doctor). Tests are usually done quickly because the risk of stroke is highest in the days and weeks after an episode.

Treatment

Treatment focuses on preventing a stroke. The plan depends on the cause, but it often includes medications to reduce blood clotting and control risk factors, and sometimes surgery to open a narrowed carotid artery.

Self-care at home

• Quit smoking if you smoke
• Control your blood pressure with lifestyle changes and medications as prescribed
• Eat a healthy diet low in salt and saturated fat
• Exercise regularly as advised by your doctor

Medical treatments

Your doctor may prescribe medications to prevent blood clots (such as antiplatelet or anticoagulant medicines) and to control blood pressure and cholesterol. It is important to take these exactly as prescribed. Do not stop or change them without talking to your doctor.

When is surgery considered?

If a carotid artery is severely narrowed, your doctor may recommend a procedure called carotid endarterectomy to remove the plaque and restore blood flow. This surgery can lower the risk of stroke.

Living with this condition

After an episode of amaurosis fugax, your main focus will be on managing your risk factors and taking your medications as prescribed. You will have regular check-ups with your healthcare team to monitor your condition.

Lifestyle tips

• Take all medications exactly as prescribed
• Monitor your blood pressure at home if advised
• Stay physically active as able
• Eat a heart-healthy diet
• Avoid smoking and limit alcohol

Diet and exercise

A diet rich in fruits, vegetables, whole grains, and lean protein, and low in salt, unhealthy fats, and sugar can help control blood pressure and cholesterol. Aim for at least 30 minutes of moderate exercise most days, but talk to your doctor before starting a new exercise programme.

Mental health and emotional wellbeing

Having an episode of temporary vision loss can be frightening. It is normal to feel anxious about the possibility of a stroke. Talk to your healthcare team about your concerns. They can support you and connect you with resources.

Prevention

You can reduce your risk of amaurosis fugax and stroke by managing the underlying causes. This includes controlling high blood pressure, treating high cholesterol, managing diabetes, quitting smoking, eating a healthy diet, and staying active. If you have atrial fibrillation, it is important to take your blood-thinning medicines as prescribed.

Complications

If left untreated

• Stroke
• Permanent vision loss
• Disability from stroke
• Death

Long-term outlook

With prompt medical care and treatment, the risk of stroke can be significantly reduced. Most people who have amaurosis fugax recover fully and do not have lasting vision problems. But it is a serious warning sign that should never be ignored. By working closely with your healthcare team, you can take steps to protect your health.

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