25th December 2023

Management

Management of TVL is directed at the underlying cause.

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) demonstrated that patients with ocular TIA had a 2-year stroke incidence of 17%. This risk may be reduced in patients who have carotid stenosis greater than 70%, reducing future risks of stroke. Individuals with <75% ipsilateral internal carotid artery stenosis or complete carotid occlusion are treated with anti-platelet agents. Those with >75% stenosis should be referred to a vascular surgeon for consideration of endarterectomy or carotid artery stenting.

Ischaemic heart disease is the most common cause of death following an episode of amaurosis fugax. Vascular risk factors, such as hypertension, diabetes, and hyperlipidaemia should be addressed.

References 

• Ahmed R, Foroozan R. Transient monocular vision loss. Neurol Clin 2010;28:619-629.
• Barnett HJ, Taylor W, Eliasziw M et al. Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis. N Engl J Med 1998; 339:1415-1425
• Poole CJ, Ross Russell RW Mortality and stroke after amaurosis fugax. Journal of Neurology, Neurosurgery & Psychiatry 1985;48:902-905.