[Ocular ischemic syndrome : An important differential diagnosis]

Ocular ischemic syndrome is a rare disease, which must be considered as a differential diagnosis in cases of painful loss of vision.

A 63-year-old male patient presented as an emergency in our consultation with hyphemia and decompensated intraocular pressure of the right eye. The right eye had been painful for 3 weeks. Apart from nicotine abuse, no relevant pre-existing medical conditions were known. With suspected iritis, the initial treatment was performed with eye drops containing a corticosteroid. After initial improvement in symptoms, an acute deterioration occurred with decrease in visual acuity and increased pain starting 2 days previously. Biomicroscopic examination revealed rubeosis iridis with hyphemia. Due to the hyphemia the view of the fundus was greatly reduced but there were no indications for retinal bleeding. In gonioscopy a chamber angle closure was evident. Fluorescence angiography showed a significantly longer arm-retina time, a delayed arteriovenous passage, peripheral vascular leaks and reduced fluorescence of the choroid. An ocular ischemic syndrome was suspected, therefore, duplex sonography of the carotid arteries and computed tomography angiography were performed and showed complete stenosis of the right internal carotid artery and moderate stenosis of the left internal carotid artery. An intravitreal administration of anti-VEGF and panretinal laser photocoagulation were carried out. Furthermore, an evaluation of the cardiovascular risk factors was initiated as part of the interdisciplinary investigation.