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Consultant Ophthalmologist, Cataract & Refractive Surgeon
BMedSci BM BS MRCS MRCSEd MRCOpth FRCOphth MMedLaw PgD Cataract & Refractive Surgery

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