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Amaurosis fugax
One eye goes dark for seconds to minutes and comes back. The eye is fine afterwards — the question is not the eye but where the blockage came from.
Also known as: amaurosis fugax · transient monocular blindness · a curtain coming down · TIA of the eye
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Sight in one eye drops out and comes back. It is usually described as a curtain falling from above or rising from below, less often as a grey cloud or a switching-off. It lasts seconds to a few minutes, practically always under half an hour, and afterwards sight is as it was. Nothing hurts.
The episode itself has passed without damage. Its significance lies in what set it off: for a short time the blood supply to the retina was interrupted. The commonest reason is a small clot or a crumb of calcium that broke off a deposit in the neck artery and was carried into the eye’s artery until it moved on. Other sources are the heart — above all in an irregular rhythm — and, beyond the age of fifty, inflammation of the temporal arteries.
This event is therefore for the vessel what a brief lapse in the brain is: a warning. The risk of a stroke is highest in the days immediately afterwards and then falls. That is exactly why the work-up is urgent, even though everything looks normal again by the time of the appointment. What is examined: the neck arteries by ultrasound, the heart rhythm, blood pressure, blood sugar and blood fats; over fifty, inflammation values are added.
Two things are regularly confused with this. A migraine aura involves both eyes — it stays when one eye is covered —, shows zigzag lines and shimmering rather than darkness, and travels over twenty to thirty minutes. And a few seconds of greying on standing up or bending down, often in both eyes, points to blood pressure or raised pressure in the skull rather than to a clot.
The risk of a stroke is highest right after the event and falls afterwards. Taking an appointment in a fortnight lets the window pass in which the work-up helps most.
Ultrasound of the neck arteries, heart rhythm over a longer period, blood pressure, blood sugar and blood fats, plus the back of the eye. Over fifty, inflammation values are added. This list can be taken along — it replaces no assessment, but it gives the conversation a shape.
Time, duration in seconds or minutes, which eye, from which side the curtain came, what else was going on. After three days that account has blurred, and it is exactly the one that gets asked for.
Aura: both eyes, zigzag lines, travels slowly, twenty to thirty minutes, often followed by headache. Circulation: seconds, usually both eyes, on standing or bending, often with blacking out and dizziness. Amaurosis fugax: one eye, darkness, seconds to minutes, no trigger.
Blood pressure, blood sugar, blood fats, smoking, rhythm. Unspectacular, and still the strongest, because it works at the source and not at the eye. Which of them counts for whom is decided by the findings — not by the list.
The typical account: the picture darkens from above downwards or from below upwards, like a blind. After seconds to minutes it runs back the same way. One eye, not both.
No lasting gap, no pain, no red eye. It is exactly this full recovery that keeps the episode from being mentioned — and it is the reason it belongs mentioned.
If next time one manages to cover an eye, one has the key piece of information. If the loss stays when the good eye is covered, it sits in the affected eye. If it involves both eyes alike, it is about the visual pathway in the brain and not the eye artery.
Speech trouble, a drooping corner of the mouth, weakness or numbness on one side of the body, dizziness or double vision in the same period change the urgency at once: it is then no longer an eye matter but the emergency number.
If a new headache at the temple, a tender temporal artery or pain on chewing that forces a pause come with it, inflammation of the temporal arteries belongs ruled out the same day. There, treatment starts before confirmation.
Over fifty it belongs in the set, because inflammation of the temporal arteries can cause the same blackouts and takes sight if untreated. A normal value does not rule it out when the complaints fit.
Measured together with the ESR; the two complement each other, and it happens that one of them is off.
Blood sugar over the past two to three months. It belongs to the vascular work-up because it co-determines the state of the small vessels.
The value the deposit in the neck artery hangs on — that is, the place the particle usually comes from.