Venous stasis retinopathy of stenotic or occlusive carotid origin

Venous stasis retinopathy is an uncommon sign of carotid artery obstruction. It is found in those patients who have very severe stenosis, or complete occlusion, of the arterial lumen. Affected patients usually have advanced multivessel disease with compromise of both carotid arteries. The retinopathy is ipsilateral to the more severely compromised artery; it is caused by progressive, chronic hypoxic injury to retinal tissues, which causes an ophthalmoscopic picture of venous dilation and tortuosity, retinal hemorrhages, macular edema, and eventual neovascular proliferation. The retinal findings are quite similar to those found in diabetic retinopathy, except for unilaterality corresponding to the more obstructed artery and early onset in the retinal midzone rather than the posterior pole. The primary treatment is panretinal photocoagulation to ischemic areas, followed by either medical or surgical management of obstructive carotid disease or carotid endarterectomy alone.