Neuro-Ophthalmic
Amaurosis Fugax
Also known as: transient monocular vision loss, TMVL, amaurosis fugax, curtain vision loss, TIA eye, transient visual loss, fleeting vision loss, Hollenhorst plaque
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Transient loss of vision in one eye from temporary retinal ischaemia, classically described as a shade descending and then clearing within minutes. Examination between episodes is frequently unremarkable, so the history carries the assessment, and a visible retinal embolus points to a carotid source. It is a warning of impending stroke and warrants emergency carotid and cardiac assessment, with giant cell arteritis considered in every patient over 50.
Recognition
Symptoms: what patients report
- Painless, transient complete or partial loss of vision in one eye.
- Classic 'curtain falling' or 'shade descending' over the visual field.
- Episode resolves fully within minutes, typically under 5–10 minutes.
- Possible associated ipsilateral headache if carotid artery source.
- Associated neurological symptoms (weakness, speech difficulty) must be asked about.
Signs: what the examination shows
- Ocular examination often completely normal between episodes.
- Hollenhorst plaque (bright yellow cholesterol embolus at retinal artery bifurcation) — confirms carotid embolic source if seen.
- Relative afferent pupillary defect if there is persistent visual loss.
- Check blood pressure bilaterally — asymmetry suggests carotid/subclavian disease.
What OptoGuide™ covers for amaurosis fugax
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Amaurosis Fugax (Transient Vision Loss) — EyeWiki
- Transient Vision Loss — NANOS
- The Neuro-Ophthalmology Survival Guide (Pane, Miller & Burdon) — standard reference text
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.