Sudden Loss of Vision (Unilateral) affecting whole field of vision

Is this amaurosis fugax?

This is a transient ischaemic attack (TIA) of the retinal circulation.

Indications

• Patient is usually elderly with cardiovascular risk factors.
• Sudden onset.
• Grey/black curtain coming down or up across vision, obscuring vision, which usually disappears within 30 minutes. Vision is back to normal after an attack.

What do I find?

• Usually no ocular abnormality. May have carotid bruit.

What do I do?

• Assess risk factors for embolic stroke.
• Rare but important – GCA manifests as amaurosis fugax – worth checking ESR/CRP

Is this ocular migraine?

Indications

• Patient usually younger.
• Patient usually complains of missing patches of vision, flashes, scintillating colours or lights, typically lasting 20 minutes.
• Headache not always present
• Episodes may recur

What do I find?

• Usually nothing
• What do I do?
• Reassure as long as the vision continues to return to normal