Ocular ischaemia, or Ocular Ischaemic Syndrome (OIS), arises when blood supply to the eye becomes critically reduced – often due to significant narrowing of the carotid artery – leading to vision loss and eye pain. Timely evaluation is crucial, as it may signal serious cardiovascular risk.
OIS is a rare but potentially serious condition resulting from ocular hypoperfusion – insufficient blood flow and oxygen to the eye. The most common cause is carotid artery stenosis, where artery walls thicken and narrow by greater than 90%, often due to atherosclerosis. Other less frequent causes include giant cell arteritis, fibromuscular dysplasia, Takayasu arteritis, Behçet’s disease, and dissecting aneurysm of the carotid artery. While men are affected more often than women, it typically presents between ages 50 and 80. Left unmanaged, OIS can result in significant vision impairment and systemic health risks.
Symptoms
- Visual loss (ranging from gradual to sudden)
- Persistent, dull orbital pain
- Eye signs such as uveitis, new blood vessel growth (neovascularisation), uneven cataract development, slow light reflex, corneal swelling, dilated retinal veins, cherry-red spot, narrowed retinal arteries, cotton–wool spots, or bleeding in the vitreous humor
Diagnosis
Diagnosis involves a thorough ocular assessment – including retina examination and fluorescein angiography – combined with vascular imaging, such as carotid duplex ultrasound or Doppler studies, to assess blood flow. Differentiation from diabetic retinopathy or central retinal vein occlusion is also important. Coordination with neurologists, cardiologists, and vascular surgeons helps manage both ocular and systemic health risks.
Treatment options
Treatment takes a dual approach:
Ocular Interventions
Includes medications, laser therapy, or surgical procedures to address eye-specific complications such as neovascular glaucoma or macular edema.
Systemic Vascular Treatment
Surgical (such as carotid endarterectomy or stenting) or medical interventions to restore proper blood flow in the carotid arteries and reduce the risk of stroke.
