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Ocular ischemic syndrome
Last reviewed: 04.07.2025
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Ocular ischemic syndrome is a rare condition resulting from secondary hypoperfusion of the eyeball in response to acute ipsilateral atherosclerotic stenosis of the carotid arteries. It usually occurs in individuals over 60 years of age and may be associated with diabetes, hypertension, coronary heart disease, and cerebrovascular disease. Death occurs within 5 years due to heart disease in 40% of cases. Patients with ocular ischemic syndrome may have a history of amaurosis fugax due to retinal embolism.
[ Symptoms of ocular ischemic syndrome
In 80% of cases, ocular ischemic syndrome is a unilateral process and affects both the anterior and posterior segments. Signs vary and may be subtle, leading to missed or incorrect diagnosis.
Ocular ischemic syndrome usually manifests itself as a gradual decrease in vision over several weeks or months, sometimes sudden loss of vision is possible.
What's bothering you?
Diagnostic criteria for ocular ischemic syndrome
Front section
- Diffuse episcleral injection.
- Corneal edema and striae.
- Fleur of aqueous humor, sometimes a minor cellular reaction (ischemic pseudoiritis).
- The pupil is of medium width, the reaction is sluggish.
- Iris atrophy.
- Usually rubeosis iridis with transition to neovascular glaucoma.
- Cataracts develop in later stages.
Fundus of the eye
- Dilation of veins with possible tortuosity and narrowing of arterioles.
- Microaneurysms, pinpoint and spotty hemorrhages, less commonly cotton-wool foci.
- Proliferative retinopathy with neovascularization in the disc area and, less commonly, outside it.
- Macular edema.
- Most cases are characterized by spontaneous pulsation of the artery, more pronounced near the disc, which can also be caused by gentle pressure on the eyeball (digital ophthalmodynamometry).
Foveal angiography: delayed and heterogeneous filling of the choroid, prolongation of the arteriovegetative phase time, lack of perfusion of retinal capillaries, late oozing and significant staining of the arteries.
Tactics
- Changes in the anterior chamber are relieved with local steroids and mydriatics.
- Neovascular glaucoma requires conservative or surgical intervention.
- >Proliferative retinopathy requires panretinal laser coagulation, despite less satisfactory results compared to proliferative diabetic nephropathy.
What do need to examine?
Differential diagnosis of ocular ischemic syndrome
Non-ischemic central retinal vein occlusion
- Similarities: unilateral retinal hemorrhages, varicose veins and cotton wool spots.
- Differences: normal perfusion of retinal arteries, more hemorrhages, mainly in the form of "flame" spots, there is edema of the optic disc.
Diabetic retinopathy
- Similarities: punctate and patchy hemorrhages and retina, yen tortuosity and proliferative retinopathy.
- Differences: usually bilateral, hard exudates present.
Hypertensive retinopathy
- Similarities: thinning of arterioles and local narrowing, hemorrhages and cotton-wool spots.
- Differences: Always two-sided, no yen changes.