Ocular ischaemic syndrome occurs when chronic poor blood flow from severe carotid artery disease affects the eye. It can threaten sight and signal life-threatening vascular problems.
Symptoms and findings
Reduced perfusion leads to a mix of anterior and posterior segment signs.
- Gradual vision loss, dull eye ache, or amaurosis fugax
- Mid-peripheral dot-and-blot haemorrhages and narrowed arteries
- Iris and angle neovascularisation with raised pressure in advanced cases
- Often associated with carotid bruits and systemic vascular disease
Management
Treatment requires both ophthalmic and systemic care.
- Urgent vascular assessment and management of carotid stenosis
- Anti-VEGF injections and panretinal photocoagulation for neovascularisation
- Pressure-lowering therapy for secondary glaucoma
- Close monitoring of cardiovascular risk factors and stroke prevention
