Postprandial transient visual loss: A symptom of critical carotid stenosis

Purpose: The authors report the association of transient visual loss after eating meals with severe carotid occlusive disease₁ and propose a hypothesis for its pathophysiology. Methods: Description of clinical history and examination, radiologic and other studies in two patients with postprandial transient visual loss, and review of the literature for three related cases. Results: Two women, 59 and 65 years of age, presented with splotchy visual loss lasting up to more than 1 hour in the left and both eyes, respectively. In both patients, the visual loss was precipitated by eating a meal. Radiologic investigations revealed 90% stenosis of the left internal carotid artery in the first patient and occlusion of the right internal carotid artery and 40% to 70% stenosis of the left internal carotid artery in the second patient. Conclusions: Visual loss after eating a meal may result from hypoperfusion of the retinal and choroidal circulations and is suggestive of severe carotid occlusive disease.