Ophthalmic artery stenosis presenting as amaurosis fugax

Amaurosis fugax is a classic clinical presentation of carotid arterial embolism. Amaurosis results from ischemia to the retinal tissue, is vision threatening, and an ophthalmological emergency. Stenoses isolated within the distal arteries supplying the retina (including the ophthalmic artery) are likely underdiagnosed during the workup of amaurosis, as evaluation is typically focused on carotid artery disease resulting in embolic events. Isolated stenosis of the ophthalmic artery may also be underrecognized by clinicians, as its discussion appears limited to case reports within the literature. Our case report describes a young and otherwise healthy 39-year-old female patient without typical risk factors who presented with features suggestive of amaurosis fugax. She underwent full neuro-ophthalmologic workup and was found to have an isolated 3mm severe stenosis of her ipsilateral ophthalmic artery diagnosed with magnetic resonance angiography (MRA). The remainder of the workup was unremarkable, and the patient was started on empiric daily aspirin. The patient has been followed clinically for over 3 years without recurrence of symptoms. This report is important, as it highlights the importance of non-invasive angiographic imaging in the workup of patients with amaurosis fugax. This case may encourage physicians to specifically request analysis of the ophthalmic artery, particularly when other etiologies of amaurosis are not found. Identification of localized ophthalmic artery disease may lead to appropriate therapy and may also prevent further episodes of visual loss, even in atypical patient populations, as it has in our case.