[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Approach by symptom](https://durgical.com/en/ophthalmology/areas/approach/) › Transient visual loss (amaurosis fugax)

# Transient visual loss (amaurosis fugax)

- Clinical approach

Vision that goes dark in one eye for minutes and comes back is a warning stroke of the eye. It needs the same urgent workup as a transient ischaemic attack.

Updated Nov 5, 2026

**See it in 3D:** [Retina](https://durgical.com/en/anatomy/retina/) · [Central retinal artery](https://durgical.com/en/anatomy/central-retinal-artery/) · [Ophthalmic artery](https://durgical.com/en/anatomy/ophthalmic-artery/)

## Key points

- Amaurosis fugax = retinal transient ischaemic attack: same-day stroke workup.
- Hollenhorst plaque = cholesterol embolus from the carotid.
- Seconds, on standing, with headache = papilloedema.
- Over 50: exclude giant cell arteritis.

## What it is

Transient monocular visual loss, classically a curtain falling over one eye for a few minutes, is most often an embolus from the carotid artery or the heart passing through the retinal circulation. It is a transient ischaemic attack of the retina. Other causes depend on how long it lasts and whether one or both eyes are affected: seconds with posture change in papilloedema, 20 to 30 minutes of shimmering zigzags in both eyes in migraine aura, and giant cell arteritis in older people.

## Red flags

- Monocular episode lasting minutes in an adult with vascular risk factors: carotid or cardiac embolism.
- Age over 50 with headache, jaw claudication or scalp tenderness: giant cell arteritis.
- Episodes lasting seconds on standing or bending, with headache: papilloedema (transient visual obscurations).
- Repeated episodes or a visible bright embolus in a retinal artery.
- Any weakness, numbness or speech disturbance at the same time.

## Step-by-step approach

- Ask whether one eye or both were affected and whether covering one eye was tried.
- Ask the duration, the pattern (curtain, blur, shimmering lights) and how often it has happened.
- Ask vascular risk factors, palpitations, neurological symptoms and the symptoms of giant cell arteritis.
- Examine visual acuity, pupils and fundus: look for emboli at artery branch points and for disc swelling.
- Listen for a carotid bruit, check the pulse rhythm and measure blood pressure.

## Transient visual loss by pattern

| Pattern | Eyes | Think of | Next step |
| --- | --- | --- | --- |
| [Curtain for 2 to 30 minutes](https://durgical.com/en/conditions/ischaemic-stroke/) | One | Carotid or cardiac embolism | Same-day stroke workup |
| [Episodes with headache, over 50](https://durgical.com/en/conditions/giant-cell-arteritis/) | One or both | Giant cell arteritis | ESR, CRP and steroids the same day |
| [Seconds on standing up](https://durgical.com/en/conditions/idiopathic-intracranial-hypertension/) | One or both | Papilloedema | Urgent brain imaging |
| [Shimmering zigzag spreading over 20 to 30 minutes](https://durgical.com/en/conditions/migraine/) | Both | Migraine aura | Clinical diagnosis if typical |
| [Minutes, both eyes, with dizziness or double vision](https://durgical.com/en/conditions/ischaemic-stroke/) | Both | Vertebrobasilar ischaemia | Same-day stroke workup |

## Keys to the differential

- A bright yellow cholesterol embolus (Hollenhorst plaque) at a retinal artery branch points to the carotid artery.
- Most patients have a normal eye exam by the time they are seen: the history makes the diagnosis.
- Retinal migraine, monocular loss with headache in a young person, is a diagnosis of exclusion.
- Atrial fibrillation is a common cardiac source; an ECG is part of the first evaluation.

## Next step / Initial management

- Treat transient monocular visual loss as a transient ischaemic attack: same-day emergency stroke evaluation with brain imaging, carotid imaging (Doppler or angiography), ECG and rhythm monitoring.
- Start secondary prevention through the stroke pathway: antiplatelet therapy, statin and risk-factor control, with carotid surgery if there is significant symptomatic stenosis.
- Over 50 with symptoms of giant cell arteritis: ESR and CRP, start corticosteroids the same day and refer.
- Episodes with headache or swollen discs: urgent brain imaging for raised intracranial pressure.
- Ophthalmology exam to look for emboli and rule out an eye cause.

## Test yourself

Think of the answer, then tap the question to see it.

## How should a 68-year-old with five minutes of monocular blackout be managed?

As a transient ischaemic attack: same-day stroke workup with brain and carotid imaging, ECG and secondary prevention.

## What is a Hollenhorst plaque?

A bright cholesterol embolus seen at a retinal artery branch, usually from an atheromatous carotid artery.

## What do visual obscurations lasting seconds on standing suggest?

Papilloedema from raised intracranial pressure; it needs urgent brain imaging.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ophthalmology/transient-visual-loss/)

## Connections

## See it in 3D 3

The structures of Durgical's 3D anatomy where it is found.

- [Retina](https://durgical.com/en/anatomy/retina/)
- [Central retinal artery](https://durgical.com/en/anatomy/central-retinal-artery/)
- [Ophthalmic artery](https://durgical.com/en/anatomy/ophthalmic-artery/)

## Related 4

- [Sudden painless visual loss](https://durgical.com/en/ophthalmology/sudden-painless-visual-loss/)
- [Central retinal artery occlusion: an eye stroke](https://durgical.com/en/ophthalmology/central-retinal-artery-occlusion-an-eye-stroke/)
- [The swollen optic disc: papilloedema or not](https://durgical.com/en/ophthalmology/the-swollen-optic-disc-papilloedema-or-not/)
- [Giant cell arteritis and the eye: treat before the biopsy](https://durgical.com/en/ophthalmology/giant-cell-arteritis-and-the-eye-treat-before-the-biopsy/)

## Related conditions 5

- [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/)
- [Giant cell arteritis](https://durgical.com/en/conditions/giant-cell-arteritis/)
- [Migraine](https://durgical.com/en/conditions/migraine/)
- [Idiopathic intracranial hypertension](https://durgical.com/en/conditions/idiopathic-intracranial-hypertension/)
- [Central retinal artery occlusion](https://durgical.com/en/conditions/central-retinal-artery-occlusion/)

[← All of ophthalmology](https://durgical.com/en/ophthalmology/)

Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.

Sources: [Amaurosis Fugax](https://www.ncbi.nlm.nih.gov/books/NBK470528/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Retinal Migraine Headache](https://www.ncbi.nlm.nih.gov/books/NBK507725/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Giant Cell Arteritis (Temporal Arteritis)](https://www.ncbi.nlm.nih.gov/books/NBK459376/) (StatPearls Publishing (NCBI Bookshelf), 2024).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/ophthalmology/transient-visual-loss/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/transient-visual-loss/