Light induced amaurosis: a rare symptom of carotid stenosis
DOI:
https://doi.org/10.48750/acv.428Palavras-chave:
Light induced amaurosis, carotid stenosis, transient vision lossResumo
INTRODUCTION: Light induced amaurosis refers to a transient monocular or binocular vision loss triggered by bright lights. Like amaurosis fugax, light induced amaurosis is associated with carotid artery stenosis but they differ from each other in presentation and pathophysiology. It is thought to be an impairment in the regeneration of retinal visual pigments caused by the inability of carotid circulation to sustain the increased metabolic activity occurring when the retina is exposed to bright lights. With this report we aim to present a case of light induced amaurosis and its management.
CASE REPORT: We describe a 74-year-old man with the isolated complaint of monocular visual loss from his left eye when exposed to bright lights. These episodes were self-limited and lasted for several minutes. His vision was reportedly good between episodes. He also complained of headache and dizziness. There were no other focal neurological deficits present. The patient had a history of peripheral artery disease, chronic heart failure, hypertension, dyslipidaemia, permanent atrial fibrillation and had a history of heavy smoking in the past. Chronic medical therapy included anticoagulation with rivaroxaban, antiplatelet therapy with acetylsalicylic acid and atorvastatin. Imaging studies (doppler ultrasonography and Computed tomography angiography) revealed a significant morphologic stenosis of the left common carotid artery, left internal carotid artery with sub occlusive disease and right internal carotid artery with 70-75% stenosis (North American Symptomatic Carotid Endarterectomy Trial - NASCET). The vertebral arteries study did not reveal significant morphologic disease. The patient was submitted to left common and internal carotid artery endarterectomy and Dacron patch angioplasty. The visual symptoms progressively improved after surgical treatment. The dizziness and headache were completely gone.
CONCLUSION: Light induced amaurosis is a rare and less known symptom associated with severe carotid artery stenosis. Its timely recognition is important to not deprive patients of timely treatment.
Downloads
Referências
Tsai J, Ramanan B, Modrall JG, Hurd PW, Tsai S. Light-Induced Amaurosis—A Case Report and Brief Literature Review. Ann Vasc Surg. 2020;66:671e1-4
Wu A, Sangha N. Limb-Shaking Syndrome with Light-Induced Amaurosis Fugax: A Rare Presentation of Near-Occlusive Carotid Disease. Vol. 4, Movement Disorders Clinical Practice. Wiley-Blackwell; 2017. 465–6
Roberts DK, Sears JM. Light-induced amaurosis associated with carotid occlusive disease. Optom Vis Sci 1992;69:889–97
Makhkamova DK. Etiopathogenesis of ocular ischemic syndrome. Vestn Oftalmol 2017;133:120–4
Shin YW, Kim JM, Jung KH, Noh WY, Lee ST, Chu K, et al. Light-induced amaurosis fugax due to severe distal internal carotid artery stenosis: In view of managing ocular ischemic syndrome. J Neurol 2013;260:1655–7
Lindegger DJ, Stappler T, Abdulghafor M, Elalouf M, Borruat FX, Wolfensberger TJ, et al. Transient Electroretinographic Changes during Light-Induced Amaurosis in Severe Carotid Artery Stenosis Measured with a Novel Portable Handheld Device. Klin Monatsbl Augenheilkd 2019;236:584–6
Furlan AJ, Whisnant JP, Kearns TP. Unilateral Visual Loss in Bright Light: An Unusual Symptom of Carotid Artery Occlusive Disease. Arch Neurol 1979;36:675–6
Ohba N, Ohba A. Nyctalopia and hemeralopia: The current usage trend in the literature. Br J Ophthalmol 2006;90:1548–9
Katz BJ, Digre KB. Diagnosis, pathophysiology, and treatment of photophobia. Surv. Ophthalmol 2016;61:466–77
Kaiboriboon K, Piriyawat P, Selhorst JB. Light-induced amaurosis fugax. Am J Ophthalmol 2001;131:674–6
