Ocular ischemic syndrome: recognition and differential diagnosis, a literature review

Mindaugas Variakojis1, Vaiva Mačionienė2 

1 Lithuanian University of Health Sciences, Kaunas, Lithuania.

2 Department of Ophthalmology at the Kauno Klinikos Hospital of Lithuanian University of Health Sciences


Ocular ischemic syndrome is a group of symptoms caused by acute or chronic arterial insufficiency of the eye. It is a rare disease that threatens optic nerve damage, leading to irreversible visual impairment. The syndrome is most commonly associated with obstructive carotid artery disease. Interestingly, half of the patients with marked atheromatous carotid artery lesions avoid the development of ischemic eye syndrome. This is associated with efficient collateral circulation. The syndrome manifests as impaired visual function, pain in the eye area, changes in the anterior and posterior segments of the eye, and is sometimes characterized by orbital infarction syndrome. Eye symptoms are not always specific. It is necessary to differentiate with other eye diseases, to evaluate comorbidities. Ophthalmoscopy, fluorescent angiography (FAG), biomicroscopy are the main ophthalmological examinations. A significant pathophysiological mechanism that develops during ischemic eye syndrome is neovascularization. The process can be observed in the iris tissue, in the retina, in the area of ​​the optic disc. Neovascularization of the anterior segment of the eye can lead to structural changes in the angle of the anterior chamber of the eye, the development of neovascular glaucoma. Ischemia and secondary neovascular glaucoma have the greatest significance for optic nerve damage, and irreversible impairment of visual function occurs. Treatment of ischemic eye syndrome is complex, requiring ophthalmologists, cardiologists, neurologists, vascular surgeons, neurosurgeons, and others. cooperation between medical professionals. The goal of treatment is to eliminate the causes of ischemia. The goal of the ophthalmologist is to diagnose the disease in a timely and accurate manner, to reduce inflammation of the anterior segment of the eye, retinal ischemia, to treat neovascular glaucoma, to regulate increased intraocular pressure.

Keywords: carotid artery disease, ocular ischemic syndrome, anterior segment ischemia, posterior segment ischemia, neovascularization.