Amaurosis Fugax and Cycloplegia in an Adolescent

Abstract

Amaurosis fugax (AF), mainly occurring in adults, is defined as transient monocular loss of vision lasting from seconds to minutes and may be recurrent caused vascular insufficiency, and at timed referred to as retinal migraine. Searching the literature, the diagnosis of AF was based on the patients' reports that could not be examined during the acute short- lived events. We present herein a unique case of a 14-year-old male with recurrent AF attacks in whom we able to examine during the acute event. He started suffering from acute events of right monocular blindness for the last six months lasting up to five minutes at a frequency of 2 events per months. No preceding sensory or motor symptoms were experienced with no accompanying headaches following. No family history of headaches was detected. On examination of these acute events he lost his vision instantly and we observed marked dilatation of the right pupil without any response to light. The event of AF lasting commonly for up to 5 minutes and while he regained vision the right pupil was reactive again. The patient underwent a thorough investigation including MRA + MRA, echo-doppler of the carotid arteries, cardiac angiography and coagulation tests, all of which were normal. Therefore, no treatment or further investigations were suggested. On follow-up, he reported of still having episodes of acute monocular blindness which became less frequent and much shorter, not imparing his daily life activities. In conclusion, the combination of monocular blindness and cyclopgegia of the involved eye suggests hypoxic impairment of the retinal artery implying that AF along with cycloplegia during the acute event may be an unusual presentation of retinal migraine even in the absence of following pulsating headaches.