Ocular Ischemic Syndrome

Updated: Dec 07, 2018
  • Author: Igal Leibovitch, MD; Chief Editor: Andrew G Lee, MD  more...
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Ocular ischemic syndrome (OIS) encompasses the ocular signs and symptoms that result from chronic vascular insufficiency. Common anterior segment findings include advanced cataract, anterior segment inflammation, and iris neovascularization. Posterior segment signs include narrowed retinal arteries, dilated but nontortuous retinal veins, midperipheral dot-and-blot retinal hemorrhages, cotton-wool spots, and optic nerve/retinal neovascularization. The presenting symptoms include ocular pain and abrupt or gradual visual loss. [1, 2, 3, 4, 5, 6, 7]



The most common etiology of OIS is severe unilateral or bilateral atherosclerotic disease of the internal carotid artery or marked stenosis at the bifurcation of the common carotid artery. OIS may also be caused by giant cell arteritis. It is postulated that the decreased vascular perfusion results in tissue hypoxia and increased ocular ischemia, leading to neovascularization. [3, 8, 9]




United States

The true incidence of OIS is unknown. It is estimated that approximately 5% of patients with marked carotid artery stenosis present with OIS. By extrapolating data from previous studies, and by applying it to the population of the United States, approximately 1800 new cases (7.5 cases per 1 million population) are encountered per year.


The 5-year mortality rate in patients with OIS is about 40%. The leading cause of death is cardiac disease, followed by stroke and cancer. Predisposing risk factors for atherosclerosis (eg, hypertension, diabetes mellitus) have a higher prevalence in patients with OIS than in age-matched populations.


Males are affected more frequently than females, by a ratio of approximately 2:1.


OIS mainly affects elderly patients. The age range is 50-80 years, with a mean age range of 65-68 years. OIS is uncommon in patients younger than 50 years.



Patients with ocular ischemic syndrome (OIS) have a poor visual prognosis. [10, 11, 12]

The presence of iris neovascularization is an indicator of poor visual prognosis.