What is the pathophysiology of transient vision loss (TVL)?

Updated: May 21, 2019
  • Author: Andrew J Tatham, MD, MBA, FRCOphth, FEBO, FRCS(Ed); Chief Editor: Andrew G Lee, MD  more...
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Answer

Answer

Transient hypoxia of any part of the visual system can result in a temporary disturbance of vision. Compromised perfusion of the occipital lobe, the visual pathways, or the eye may be secondary to thromboembolism, hypoperfusion, or angiospasm.

Embolic occlusions of the arteries supplying the eye are a common cause of transient vision loss in adults. Emboli causing circulatory disturbances may originate in the heart or the carotid arteries. Embolic events are usually isolated, so, if visual disturbance occurs frequently, it is less likely that emboli are responsible.

Hypoperfusion may be due to hypotension, cardiac arrhythmias, anemia, heart failure, or atherosclerotic and arteritic cerebrovascular disease. Arteritic anterior ischemic optic neuropathy (AAION) may also present with transient vision loss but in general transient vision loss does not occur prior to nonarteritic AAION.

Vasospasm may cause a temporary reduction in blood flow to the visual system and transient vision loss. Some patients have had ocular examinations during the transient vision loss event demonstrating the visible vasospasm on clinical exam, fundus photography, or fluorescein angiography.

Children with transient vision loss are less likely to have an ischemic cause for their symptoms and are more likely to have a benign disorder. Causes of bilateral vision loss in children include migraine and, less commonly, epileptic seizure. [2, 3] In some children, a cause for the visual disturbance cannot be identified, and the symptoms remain medically unexplained. [2]


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