From the Guidelines
The management of amaurosis fugax (transient monocular blindness) should focus on preventing stroke by addressing the underlying cause, typically carotid artery disease, with urgent evaluation and treatment, as the risk of stroke is highest within the first 7 days and remains elevated for 30 days, as noted in the 2020 study by the Ophthalmology journal 1. The initial treatment includes antiplatelet therapy with aspirin (81-325 mg daily), clopidogrel (75 mg daily), or a combination of aspirin and extended-release dipyridamole, as well as statin medication like atorvastatin (40-80 mg daily) to stabilize atherosclerotic plaques. Some key points to consider in the management of amaurosis fugax include:
- Urgent vascular imaging, including carotid ultrasound, CT angiography, or MR angiography to assess for carotid stenosis, as recommended by the 2011 guideline on the management of patients with extracranial carotid and vertebral artery disease 1.
- For patients with significant carotid stenosis (>70%), carotid endarterectomy or stenting should be considered within 2 weeks of symptom onset, as suggested by the 2011 guideline 1.
- Blood pressure control is crucial, targeting levels below 140/90 mmHg using appropriate antihypertensives, and lifestyle modifications are important, including smoking cessation, diabetes management, regular exercise, and a heart-healthy diet, as noted in the example answer.
- The use of hyperbaric oxygen therapy (100% oxygen over 9 hours) has demonstrated efficacy over observation alone in several small randomized trials, as mentioned in the 2020 study by the Ophthalmology journal 1.
- Panretinal photocoagulation (PRP) with or without anti-vascular endothelial growth factor (anti-VEGF) therapy is recommended for patients who develop iris or retinal neovascularization, as stated in the 2020 study by the Ophthalmology journal 1. It is essential to prioritize the single most recent and highest quality study, which in this case is the 2020 study by the Ophthalmology journal 1, to guide the management of amaurosis fugax and reduce the risk of subsequent stroke.
From the Research
Management and Treatment of Amaurosis Fugax
The management and treatment of Amaurosis Fugax (Transient Monocular Blindness) involve urgent therapy during an attack, as it is considered a medical emergency for ophthalmologist's practice 2. The primary goal is to define the cause of the disease within 24 hours of the attack.
Causes and Diagnosis
Amaurosis Fugax is a syndrome with various etiopathogenesis, making diagnosis and therapy complex 2. The condition can be divided into four identifiable symptom complexes: embolic, hypoperfusion, angiospasm, and unknown, each with its underlying pathoetiology 3. The most common underlying cause is atherosclerosis of the internal carotid artery, while other causes include vasospasm, ocular migraines, and systemic lupus erythematosus 4.
Treatment Approaches
Treatment of Amaurosis Fugax may involve:
- Intravenous fluid, aspirin, and enoxaparin sodium, as seen in a case study where a patient presented with transient vision loss in one eye 4
- Thrombolysis within 6 hours from symptoms onset, which has shown benefit in subset analyses from large studies of patients with Central Retinal Artery Occlusion (CRAO) 5
- Carotid endarterectomy, which may be suitable for patients with atheromatous lesions, although it is estimated to be of minor importance as a preventive measure against stroke in the community 6
Importance of Prompt Diagnosis and Treatment
Prompt imaging is necessary to exclude other causes of Amaurosis Fugax, and a medical emergency such as ocular migraine must be managed aggressively 4. Comprehensive stroke centers can serve as ideal triage centers for patients with CRAO, providing multidisciplinary participation from vascular neurology, neuroendovascular surgery, and ophthalmology 5.