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transient monocular blindness (TMB); amaurosis fugax
Etiology:
1) transient ischemic attack (painless)
1) temporal arteritis (elevated ESR)
2) optic nerve disorders
a) optic neuritis
b) ischemic optic neuropathy
c) papilledema - pseudotumor cerebri
3) ocular disorders
a) acute glaucoma (expectation of painful vision loss) [ABIM]
b) retinal artery branch occlusion
c) central retinal vein occlusion
d) retinal detachment
e) retinal artery vasospasm
Clinical manifestations:
- may obscure only the upper or lower 1/2 of vision in one eye, the entire visual field in one eye, or may be perceived by the patient as a graying of vision
- retinal detachment may appear as a black curtain that progresses across the visual field
Special laboratory:
- dilated opthalmoscopy
- abnormal visual acuity testing or visual field testing
- eye pain
- history of glaucoma or optic neuritis
Radiology:
- carotid doppler ultrasound
- MRI of brain with diffusion weighted imaging (see TIA)
Complications:
- predicts blindness in patients with temporal arteritis [4]
Management:
1) treat transient ischemic attack (TIA) if likely cause
2) prognosis [2]
- epsiode of transient monocular blindness confers lower risk of subsequent stroke than does hemispheric TIA
3) carotid endarterectomy beneficial only for high-risk patients [2]
General
blindness
visual impairment
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 1021-22
- Journal Watch 21(22):180, 2001
Benavente et al, N Engl J Med 345:1084, 2001
Sacco RL, N Engl J Med 345:1113, 2001
- Medical Knowledge Self Assessment Program (MKSAP) 16,
American College of Physicians, Philadelphia 2012
- Ahmed R, Foroozan R.
Transient monocular visual loss.
Neurol Clin. 2010 Aug;28(3):619-29
PMID: 20637992
- NEJM Knowledge+ Rheumatology