Brief report: treatment of vasospastic amaurosis fugax with calcium-channel blockers

If an attack of amaurosis is prolonged, the patient is at risk of permanent visual loss. Since the 1950s, amaurosis fugax has usually been attributed to embolism from the heart or great vessels1 or to carotid occlusive disease. Because of the difficulty in differentiating between these and other causes, amaurosis fugax remains a therapeutic challenge. The attacks ceased within a day after the patient started treatment with nifedipine. Since this initial case report, we have successfully used calcium-channel blockers to treat selected patients with recurrent amaurosis fugax. The medical evaluation of each patient to exclude embolism or carotid occlusive disease consisted of echocardiography (transesophageal in two patients), carotid duplex scanning (in two patients transcranial Doppler ultrasonography was also done to confirm the absence of intracavernous carotid disease), and Holter monitoring (one patient also had 24-hour monitoring of blood pressure to rule out episodic hypotension).