A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the most disabling residual effect after a cerebral infarction. Transient vision problems can likewise be a harbinger of stroke and prompt evaluation after recognition of visual symptoms can prevent future vascular injury. In this review, we discuss the visual aspects of stroke. First, anatomy and the vascular supply of the visual system are considered. Then, the different stroke syndromes which involve vision are discussed. Finally, topics involving the assessment, prognosis, treatment and therapeutic intervention of vision-specific stroke topics are reviewed.

The ophthalmic artery is the first branch of the internal carotid artery. It comes off just distal to the cavernous sinus. The ophthalmic artery gives off many branches, which supply the orbit, meninges, face, and upper nose. When the ophthalmic artery is occluded, it can compromise vision. The ophthalmic artery comes off the internal carotid artery on the medial side of the anterior clinoid process and traverses anteriorly through the optic canal and just lateral to the optic nerve. The following are branches of the ophthalmic artery: 1. The first branch of the ophthalmic artery is the central retinal artery that runs in the dura mater of the optic nerve. It then moves further along and supplies the inner layers of the retina. 2. The second and the largest branch of the ophthalmic artery is the lacrimal artery. It also enters the orbit and traverses along the superior edge of the lateral rectus muscle. It supplies the eyelids, lacrimal gland, and conjunctiva. 3. The ophthalmic artery gives off several posterior ciliary arteries that pass through the sclera and supply the posterior uveal tract. Because the posterior ciliary vessels are end vessels, sudden occlusion can produce infarction in the region of the choroid. 4. The ophthalmic artery also gives off the inferior and superior muscular vessels that supply the extraocular muscles. The supraorbital artery is also a branch of the ophthalmic artery and passes through the supraorbital foramen to supply the skin of the forehead and Levator palpebrae muscle. 5. Other branches of the ophthalmic artery include the ethmoid arteries, medial palpebral vessels, and terminal branches.  When there is occlusion of the ophthalmic artery, it can result in an ischemic syndrome. Amaurosis fugax is a condition associated with temporary, painless loss of vision due to either an embolic phenomenon or hypoperfusion. Emboli to the ophthalmic artery usually originate from the carotid artery bifurcation. One may visualize Hollenhorst bodies (a.k.a., Eickenhorst plaques) in the retina during fundoscopic evaluation. When there is a sudden, painless loss of vision in one eye, it is recommended that one obtain a duplex ultrasound of the neck to assess the carotid artery for atherosclerotic plaques.

The term amaurosis fugax is often used interchangeably to describe transient visual loss (TVL). However, it is employed widely in medicine to refer to any cause of transient monocular visual loss. Here, we will refer to amaurosis fugax only in the context of transient monocular visual loss associated with vascular thromboembolic events arising from the internal carotid arterial system.