Transient monocular vision loss

Transient monocular visual loss

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Transient monocular visual loss

The term Transient loss of vision can be used for episodes of reversible visual loss lasting less than 24 hours. Transient monocular visual loss (“ocular transient ischemic attack [TIA]”) is usually caused by a retinal embolus from ipsilateral carotid disease or the heart.

The visual loss is characteristically described as a curtain passing vertically across the visual field with complete monocular visual loss lasting a few minutes and a similar curtain effect as the episode passes (amaurosis fugax; also called “fleeting blindness”).

An embolus is rarely seen on ophthalmoscopy. Other causes of transient, often recurrent, visual loss due to ocular ischemia are giant cell arteritis, hypercoagulable state (such as antiphospholipid syndrome), hyperviscosity, and severe occlusive carotid disease. More transient visual loss, lasting only a few seconds to 1 minute, usually recurrent, and affecting one or both eyes, occurs in patients with optic disk swelling, for example in those with raised intracranial pressure.

Treatment

All patients with possible embolic transient visual loss should be treated immediately with oral aspirin (at least 81 mg daily), or another antiplatelet drug, until the cause has been determined.

Affected patients with 70–99% (and possibly those with 50–69%) ipsilateral carotid artery stenosis should be considered for urgent carotid endarterectomy or possibly angioplasty with stenting.

In all patients, vascular risk factors (eg, hypertension) need to be controlled. Retinal embolization due to cardiac arrhythmia, such as atrial fibrillation, or hypercoagulable state usually requires anticoagulation. Cardiac valvular disease and patent foramen ovale may require surgical treatment

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