Amaurosis fugax is the transient obscuration of vision due to retinal ischemia. Typical episodes are characterized as spontaneous darkening of vision in one eye lasting minutes. However, amaurosis may present atypically. Identification of amaurosis is crucial because it may herald ischemic stroke.  

A 79-year-old man with hypertension and gout was evaluated for episodic patchy white-out of his vision in the right eye for three years. These episodes were invariably triggered by bright light and lasted up to 20 minutes, sometimes causing complete obscuration of vision in the eye before resolving spontaneously. He did not have eye pain, headache, or other neurologic symptoms during these episodes. Neurologic exam including fundoscopic exam was unremarkable. CT angiography of the head and neck suggested long-segment occlusion of his right common and internal carotid artery. However, ultrasound showed pre-occlusive waveforms throughout the extracranial carotid artery. Digital subtraction angiography was performed, confirming high-grade stenosis with preserved trace flow throughout the extracranial and intracranial internal carotid artery. He was diagnosed with amaurosis due to retinal claudication secondary to high-grade carotid artery stenosis. After a multidisciplinary discussion, carotid revascularization was not pursued due to the length of calcified plaque. He was managed medically with dual anti-platelet and high-dose statin therapy as well as permissive hypertension. His episodes fully resolved.