Abstract
Ocular ischemic syndrome must be distinguished from diabetic retinopathy. Patients with bilateral differences in the degree of retinopathy are likely to have ocular ischemic syndrome; however, diagnosis is often difficult.
We report a case of bilateral ocular ischemic syndrome with bilateral common carotid artery stenosis in which the cause of visual impairment required 5 months to diagnose. A 71-year-old man at high risk of arteriosclerosis due to hypertension, diabetes, and hyperlipidemia was found to have mild bilateral internal carotid artery stenosis on ultrasonography. He presented to an ophthalmology clinic with bilateral visual impairment and remained under observation for a diagnosis of diabetic retinopathy. Visual impairment progressed, with neovascularization of the iris and neovascular glaucoma in the right eye. Ocular ischemic syndrome was suspected; however, the existing internal carotid artery stenosis showed no evidence of progression. Computed tomography angiography (CTA) revealed bilateral common carotid artery stenosis. The interval from appearance of symptoms to the start of therapy was 5 months. Functional recovery of the right eye was regarded as unrealistic. After 2 separate stenting procedures for each eye, subjective symptoms in the left eye improved, but no improvement was identified in the right eye.
Even if little bilateral difference in retinopathy is present, early comprehensive testing is necessary, including evaluation of the common carotid artery, while also considering a diagnosis of ocular ischemic syndrome.
