A Flicker before complete darkness- Amaurosis fugax: a case report

We are reporting a case of impending hemi-central retinal artery occlusion in a hypertensive patient. A 50 year old male presented with complaints of multiple episodes of transient painless mono-ocular obscuration of vision (Amaurosis fugax) in right eye for last 2 months. He was a known case of hypertension for last 2 years with poor compliance of medicines. At the time of presentation he had best corrected visual acuity in his right eye of 20/40. On fundus examination yellowish white plaques were visible in superior 1st order branches of central retinal artery along with ocular ischemic syndrome and grade III hypertensive retinopathy. Carotid Doppler and Fluorescein Angiography were performed and ECG, Echocardiography, Complete blood count including Lipid profile were advised. The arterio-venous transit time was delayed along with occluded superior 1st order branches of central retinal artery on Fluorescein Angiography and Carotid Doppler showed Type 1 plaque formation in the posterior wall of left carotid bulb. The blood investigations were suggestive of deranged lipid profile. We prescribed Aspirin/Atorvastatin combination (75/10), Cyclandelate Tablets and Brimonidine Timolol combination eye drop.