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Update on the evaluation of transient vision loss

Authors Pula J, Kwan K, Yuen C, Kattah J

Received 22 August 2015

Accepted for publication 1 December 2015

Published 11 February 2016 Volume 2016:10 Pages 297—303


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

John H Pula,1 Katherine Kwan,2 Carlen A Yuen,3 Jorge C Kattah4

1Department of Neurology, 2Department of ophthalmology, NorthShore University HealthSystem, Evanston IL, USA; 3University of Illinois College of Medicine at Peoria, 4Department of Neurology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA

Abstract: Transient vision loss may indicate underlying vascular disease, including carotid occlusion and thromboembolism, or it may have a more benign etiology, such as migraine or vasospasm. This review focuses on the differential diagnosis and workup of patients presenting with transient vision loss, focusing on several key areas: the relationship to thromboembolic vascular disease, hypercoagulable testing, retinal migraine, and bilateral vision loss. The objective is to provide the ophthalmologist with information on how to best manage these patients. Thromboembolic etiologies for transient vision loss are sometimes managed with medications, but when carotid surgery is indicated, earlier intervention may prevent future stroke. This need for early treatment places the ophthalmologist in the important role of expediting the management process. Hospital admission is recommended in patients presenting with transient symptoms within 72 hours who meet certain high-risk criteria. When the cause is giant cell arteritis, ocular ischemic syndrome, or a cardioembolic source, early management of the underlying condition is equally important. For nonthromboembolic causes of transient vision loss such as retinal migraine or retinal vasospasm, the ophthalmologist can provide reassurance as well as potentially give medications to decrease the frequency of vision loss episodes.

Keywords: transient vision loss, TVL, amaurosis fugax, retinal migraine, ocular migraine, retinal vasospasm

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