Anterior segment ischemia secondary to carotid occlusive disease

The ischemic signs of carotid occlusive disease in the anterior segment can be summarized as follows: vasodilation in the conjunctiva, episclera, and iris; neovascularization in the iris and the anterior chamber angle with consequent neovascular glaucoma, with or without elevation of intraocular pressure; and noninflammatory uveitis with corneal edema, keratitic precipitates, flare and cells in the anterior chamber, and late development of cataract. A questionnaire was sent to neuro-ophthalmology and glaucoma specialists regarding their perceptions of this condition. On average, approximately 1 case per specialist per year was seen. One third of the respondents had seen significant ocular pressure increase in patients with rubeosis following successful vascular surgery. Most felt that panretinal photocoagulation, though not as effective as in diabetic rubeosis, did cause regression of iris and angle neovascularization. The visual prognosis following all types of treatment was not good and was insufficient to justify a clear recommendation about the advisability of aggressive management of this condition.