Bilateral Ocular Ischemic Syndrome

The purpose of this chapter is to shed light on diagnosis and management of bilateral ocular ischemic syndrome. A 67-year-old man visited the OPD with complaints of congestion in the right eye (RE) with diminution of vision in the left eye. He was known uncontrolled hypertensive and had undergone angioplasty. On examination he was noted to have neovascular glaucoma in both yes (BE). Fundus examination revealed BE had normal optic nerve head with blot hemorrhages and extensive cotton wool spots over the posterior pole. The patient was advised fundus flurescein angiography (FFA), systemic blood investigation, carotid Doppler, and 2D echo. Carotid Doppler revealed bilateral complete occlusion of internal carotid artery with atheromatous changes in the common carotid artery. A provisional diagnosis of bilateral ocular ischemic syndrome was made. BE pan-retinal photocoagulation (PRP) was done, and intravitreal anti-VEGF injection was prescribed after cardiologist’s clearance, and the patient was referred to a cardiologist and vascular surgeon for further management.