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Amaurosis fugax (transient monocular or binocular visual loss)

Syndee Givre, MD, PhD
Gregory P Van Stavern, MD
Section Editors
Paul W Brazis, MD
Jonathan Trobe, MD
Deputy Editor
Janet L Wilterdink, MD


Amaurosis fugax (from the Greek "amaurosis," meaning dark, and the Latin "fugax," meaning fleeting) refers to a transient loss of vision in one or both eyes [1]. Varied use of common terminology may cause some confusion when reading the literature. Some suggest that "amaurosis fugax" implies a vascular cause for the visual loss [2], but the term continues to be used when describing visual loss from any origin and involving one or both eyes. The term "transient monocular blindness" is also often used but is not ideal, since most patients do not experience complete loss of vision with the episode [3]. "Transient monocular visual loss" (TMVL) and "transient binocular visual loss" (TBVL) are preferred to describe abrupt and temporary loss of vision in one or both eyes, since they carry no connotation regarding etiology.

Transient visual loss, either monocular or binocular, reflects a heterogeneous group of disorders, some relatively benign and others with grave neurologic or ophthalmologic implications. The task of the clinician is to use the history and examination to localize the problem to a region in the visual pathways, identify potential etiologies, and, when indicated, perform a focused battery of laboratory tests to confirm or exclude certain causes. Therapeutic interventions and prognostic implications are specific to the underlying cause.

This topic discusses transient visual loss. Other ocular and cerebral ischemic syndromes are discussed separately. (See "Central and branch retinal artery occlusion" and "Posterior circulation cerebrovascular syndromes".)


By definition, patients with transient visual loss almost always present after the episode has resolved; hence, the neurologic and ophthalmologic examination is usually normal. Reliance is placed on the patient's description of the nature of the visual symptoms and associated features (table 1). Pertinent medical and family history may also provide valuable clues to the underlying diagnosis.

Few case series of patients with transient visual loss are reported. Details from the Framingham cohort provide some interesting insights into the challenges of evaluating this symptom. Between 1971 and 1989, participants were systematically questioned regarding specific symptoms of transient ischemic attack (TIA) and stroke; 186 of 2110 subjects reported onset of a sudden visual deficit (not necessarily transient) [4]. Follow-up evaluation determined the underlying cause to be stroke or TIA (24 percent), ocular disease (17 percent), transient monocular blindness (10 percent), and migraine (14 percent). The cause remained unknown in 22 percent, and a miscellany of etiologies comprised the remaining 12 percent.

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Literature review current through: Nov 2017. | This topic last updated: Jun 19, 2017.
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