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# Ocular ischaemic syndrome

Severe narrowing of the carotid artery starves the whole eye of blood: aching, slow visual loss and new vessels. It signals high cardiovascular risk.

Updated Nov 12, 2026

On this page

- The basics What it is
- Who gets it
- Causes
- Risk factors
- Pathophysiology

- Clinical Symptoms and signs
- Red flags
- Diagnosis
- Differential diagnosis
- Complications
- Prognosis

- Treatment Goal of treatment
- Treatment

- Study Test yourself

- Connections Connections

## What it is

Chronic hypoperfusion of the eye, usually from severe atherosclerotic stenosis or occlusion of the internal or [common carotid artery](https://durgical.com/en/anatomy/common-carotid-artery/) on the same side. It causes gradual visual loss, eye or brow ache, mid-peripheral retinal haemorrhages and new vessels on the iris. The eye is a warning of severe vascular disease, and these patients have a high risk of stroke and heart attack.

See it in 3D

- [Ophthalmic artery](https://durgical.com/en/anatomy/ophthalmic-artery/)
- [Retina](https://durgical.com/en/anatomy/retina/)
- [Iris](https://durgical.com/en/anatomy/iris/)
- [Central retinal artery](https://durgical.com/en/anatomy/central-retinal-artery/)

## Who gets it

Uncommon; mainly men over 60 with atherosclerosis, diabetes, hypertension and smoking.

## Causes

- Severe atherosclerotic carotid stenosis or occlusion
- Less often, giant cell arteritis, carotid dissection or other arteritis

## Risk factors

- Smoking
- Diabetes
- Hypertension
- Dyslipidaemia
- Coronary or peripheral artery disease

## Pathophysiology

Reduced flow through the [ophthalmic artery](https://durgical.com/en/anatomy/ophthalmic-artery/) leaves the [retina](https://durgical.com/en/anatomy/retina/), [optic nerve](https://durgical.com/en/anatomy/optic-nerve/) and anterior segment ischaemic. The retina releases VEGF, causing new vessels on the iris and angle; low perfusion of the [ciliary body](https://durgical.com/en/anatomy/ciliary-body/) can keep eye pressure deceptively normal or low.

## Symptoms and signs

- Gradual loss of vision in one eye
- Dull ache around the eye or brow
- Slow recovery of vision after bright light
- Transient visual loss

## Red flags

- Iris new vessels
- Transient monocular visual loss or neurological symptoms (stroke risk)
- Very high eye pressure (neovascular glaucoma)

## Diagnosis

**Clinical**
Narrowed retinal arteries, dilated but not tortuous veins and blot haemorrhages in the mid-periphery, often with [iris](https://durgical.com/en/anatomy/iris/) new vessels and mild [anterior chamber](https://durgical.com/en/anatomy/anterior-chamber-of-eyeball/) inflammation.

**Tests**
Cardiovascular risk assessment; ESR and CRP to exclude arteritis.

**Imaging**
Carotid Doppler, CT or MR angiography; fluorescein angiography shows delayed filling.

## Differential diagnosis

- Diabetic retinopathy
- Central retinal vein occlusion
- Uveitis
- Neovascular glaucoma from other causes

## Goal of treatment

Protect the eye from neovascular glaucoma and reduce the risk of stroke and heart attack.

## Treatment

**Surgical**
Carotid endarterectomy or stenting when appropriate, decided with vascular surgery.

**Medical**
Antiplatelet therapy, statin, blood pressure and glucose control and smoking cessation.

**Procedure**
Panretinal laser and anti-VEGF injections for new vessels; pressure control for neovascular glaucoma.

## Complications

- Neovascular glaucoma
- Severe visual loss
- Stroke and myocardial infarction

## Prognosis

Visual prognosis is often poor; survival depends on the associated cardiovascular disease.

## Test yourself

Think of the answer, then tap the question to see it.

## What usually causes ocular ischaemic syndrome?

Severe stenosis or occlusion of the carotid artery on the same side.

## Why can eye pressure stay normal despite angle new vessels?

Because poor blood flow to the ciliary body reduces aqueous production.

## What does the diagnosis mean for the patient's general health?

A high risk of stroke and heart attack, requiring vascular assessment and prevention.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/conditions/ocular-ischaemic-syndrome/)

## Connections

## Related conditions 5

- [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/)
- [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/)
- [Neovascular glaucoma](https://durgical.com/en/conditions/neovascular-glaucoma/)
- [Type 2 diabetes mellitus](https://durgical.com/en/conditions/type-2-diabetes-mellitus/)
- [Giant cell arteritis](https://durgical.com/en/conditions/giant-cell-arteritis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Ocular Ischemic Syndrome](https://eyewiki.org/Ocular_Ischemic_Syndrome) (EyeWiki, American Academy of Ophthalmology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/ocular-ischaemic-syndrome/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/ocular-ischaemic-syndrome/