Transient visual loss

Abstract

By transient visual loss we mean a drop in visual acuity or a loss of visual field, analogous to the transient ischemic attacks (TIAs) of neurological disease that last no longer than 24 h. This chapter does not discuss transient visual loss for which primary ophthalmic disorders are evident, such as intermittent angle closure glaucoma, vitreous clouding, retinal venous stasis, or the transient obscurations found in papilledema. Patients complaining of transient loss of vision frequently cause clinicians a great deal of worry, since the nature of their problem is often obscure. They may describe dramatic symptoms of visual loss without there being even a trace of objectively verifiable pathology. This can naturally lead the physician to consider a wide range of disorders, leading to a complex series of diagnostic tests, often without significant findings. Since a transient visual disturbance can be the harbinger of a retinal arterial occlusion, or even a stroke, the physician does not have the option of just giving up. Amaurosis fugax is often used as a synonym for transient visual loss, but this is not completely correct. The problem is seldom expressed as periods of true amaurosis. Indeed, there are instances in which an excess of visual images obliterates portions of the visual field, such as in the scintillating scotomas of migraine.