Ocular ischemic syndrome (OIS) is a rare condition associated with severe carotid artery occlusive disease leading to ocular hypoperfusion. It typically presents at mean age of 65, there is no racial predilection, and is two times more common in men than women. It is typically associated with systemic vascular diseases involving atherosclerosis such as coronary artery disease, stroke, peripheral vascular disease, hypertension, and diabetes. At presentation, at least 90% stenosis of the ipsilateral carotid arterial system is present and in half the cases, there is 100% occlusion. OIS can also be the initial manifestation of carotid occlusive disease in 70% of cases.
Here, we present a 58-year-old female with history of prior stroke in 2017 who presents with transient vision loss in the right eye in the last 8 months associated with pain for two days. During the ER visit, patient was found to have retina hemorrhages, cornea edema, elevated intraocular pressure, and neovascularization of both the anterior and posterior segment. At the main ER, carotid ultrasound and CT angiography showed 100% occlusion of the right internal carotid artery and ~60% occlusion of the left internal carotid argery with prior stent. This presentation goes over the differential diagnosis, multimodal imaging modality, and treatment options for OIS.
Presentation Date: 08/02/2018
Issue Date: 08/01/2020
Faculty Discussant: Norman Schatz, MD
Continuing Medical Education (CME)