Transient Monocular Blindness

Aka: Transient Monocular Blindness, Amaurosis Fugax

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II. Definition

  1. Transient Monocular Blindness (Amaurosis Fugax)
    1. Transient painless unilateral Vision Loss

III. Symptoms

  1. Acute Vision Loss ("Fleeting blindness")
    1. Sudden painless, unilateral blindness
    2. Vision returns to normal in 1-10 minutes
    3. "Shade or curtain" descends over affected eye

IV. Causes

  1. Transient Central Retinal Artery Occlusion (embolism)
  2. Optic Nerve ischemia (Giant Cell Arteritis or Temporal Arteritis)
    1. May be associated with temporal Headache, Jaw Claudication or Polymyalgia Rheumatica history

V. Labs

  1. Age over 50 years old (Temporal Arteritis risk)
    1. Erythrocyte Sedimentation Rate (ESR)
    2. C-Reactive Protein (CRP)

VI. Differential Diagnosis

  1. See Acute Vision Loss
  2. See Acute Retinal Ischemia

VII. Precautions

  1. Transient Vision Loss may progress to permanent Vision Loss (or even bilateral Vision Loss) within 1 week

VIII. Management

  1. Urgent ophthalmology Consultation within 24 hours
  2. Giant Cell Arteritis suspected (e.g. ESR/CRP increased)
    1. See Giant Cell Arteritis
    2. Consult general surgery for temporal artery biopsy
    3. Start high dose Corticosteroids
      1. Prednisone 80-100 mg orally daily OR
      2. Methylprednisolone 250 mg every 6 hours for 3 days, then transition to oral
  3. Optic Nerve ischemia from embolism suspected
    1. Evaluate as Transient Ischemic Attack
    2. Obtain MRI Brain (with diffusion weighted imaging)
    3. Evaluate carotid arteries (e.g. carotid Ultrasound, or CT or MR Angiogram Head and Neck)
    4. Electrocardiogram (evaluate for Atrial Fibrillation)
    5. Zio monitor or Holter Monitor (or telemetry if on hospital observation)
    6. Echocardiogram

IX. References

  1. Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11
  2. Biousse (2018) Ophthalmology 125:1597-607 [PubMed]

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Related Studies

Ontology: Amaurosis Fugax (C0149793)

Definition (NCI) Transient loss of vision in one eye due to retinal ischemia.
Definition (MSH) Transient complete or partial monocular blindness due to retinal ischemia. This may be caused by emboli from the CAROTID ARTERY (usually in association with CAROTID STENOSIS) and other locations that enter the central RETINAL ARTERY. (From Adams et al., Principles of Neurology, 6th ed, p245)
Concepts Sign or Symptom (T184)
MSH D020757
ICD10 G45.3
SnomedCT 267717005, 155111000, 88032003
English AMAUROSIS FUGAX, amaurosis fugax (diagnosis), amaurosis fugax, Temporary blindness due to vascular insufficiency, Amaurosis Fugax, Blindness, Monocular, Transient, Blindness, Transient Monocular, Monocular Blindness, Transient, Transient Monocular Blindness, Amaurosis Fugax [Disease/Finding], transient monocular blindness, momentary blindness, Amaurosis temporary, Amaurosis fugax (one sided temporary vision loss), Amaurosis fugax, Momentary blindness, Transient monocular blindness, AF - Amaurosis fugax, AFx - Amaurosis fugax, Amaurosis fugax (disorder), fugax; amaurosis, amaurosis; fugax
Italian Amaurosi fugace, Cecità temporanea da insufficienza vascolare, Amaurosi transitoria, Cecità monoculare transitoria, Amaurosi temporanea
Dutch tijdelijke blindheid door vasculaire insufficiëntie, amaurose tijdelijk, amaurose; fugax, fugax; amaurose, amaurosis fugax, Amaurosis fugax, Blindheid, enkelvoudig, voorbijgaand, Scotoma scintillans, Tijdelijke blindheid, Blindheid, enkelvoudig, transiënt, Enkelvoudige blindheid, transiënt
French Cécité temporaire due à une insuffisance vasculaire, Amaurose temporaire, AMAUROSE FUGACE, Amaurose transitoire, Amaurose fugace, Cécité monoculaire transitoire
German Amaurose voruebergehend, voruebergehende Blindheit infolge vaskulaerer Insuffizienz, ERBLINDUNG REVERSIBLE, Amaurosis fugax, Amaurose, monokulare, transiente, Blindheit, monokulare, transiente, Monokulare transiente Amaurose
Portuguese Amaurose temporária, Cegueira temporária por insuficiência vascular, AMAUROSE FUGAZ, Amaurose fugaz, Amaurose Fugaz, Cegueira Monocular Transiente, Cegueira Monocular Transitória
Spanish Amaurosis temporal, Ceguera temporal debida a insuficiencia vascular, AMAUROSIS FUGAZ, amaurosis fugax, amaurosis fugaz (trastorno), amaurosis fugaz, ceguera momentánea, Amaurosis fugaz, Amaurosis Fugax, Ceguera Monocular Transitoria, Ceguera Transitoria Monocular
Japanese 血管機能不全による一過性失明, ｲｯｶｾｲｺｸﾅｲｼｮｳ, ｹｯｶﾝｷﾉｳﾌｾﾞﾝﾆﾖﾙｲｯｶｾｲｼﾂﾒｲ, 黒内障-一過性, 一過性黒内障, ブラックアウト, 一過性失明, 失明-一過性, 黒くらみ, 一過性単眼失明, 単眼失明-一過性, 失明-単眼-一過性
Swedish Amauros, flyktig
Czech prchavá slepota, amaurosis fugax, prchavá slepota jednoho oka, Amaurosis fugax, Přechodná amauróza, Přechodná slepota v důsledku vaskulární nedostatečnosti
Finnish Hetkellinen sokeus
Russian SLEPOTA PREKHODIASHCHAIA, MONOKULIARNAIA SLEPOTA PREKHODIASHCHAIA, SLEPOTA MONOKULIARNAIA PREKHODIASHCHAIA, МОНОКУЛЯРНАЯ СЛЕПОТА ПРЕХОДЯЩАЯ, СЛЕПОТА МОНОКУЛЯРНАЯ ПРЕХОДЯЩАЯ, СЛЕПОТА ПРЕХОДЯЩАЯ
Korean 일과성 흑암시
Polish Ślepota przemijająca, Ślepota przejściowa
Hungarian Vascularis elégtelenség okozta időleges vakság, Átmeneti amaurosis, Amaurosis fugax
Norwegian Amaurosis fugax, Ensidig, forbigående synstap
Derived from the NIH UMLS (Unified Medical Language System)

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