The ocular pulse and intraocular pressure as a screening test for carotid artery stenosis

The ocular pulse and applanation tension were measured with a recording applanation tonometer in 38 patients suspected of having internal carotid artery stenosis. Abnormalities of the ocular pulse amplitude, intraocular pressure, or combinations of these two measurements were found in 23 (82%) of 28 patients who were subsequently found to have angiographic evidence of 50% or more stenosis of one or both internal carotid arteries. Of 10 patients without angiographic evidence of carotid stenosis the ocular pulse amplitude, intraocular pressure, or both were abnormal in five, but two patients had an ocular cause for abnormality and two of the remaining three had evidence of carotid disease in the form of atheromatous plaques. These results suggest that measurement of the amplitude of the ocular pulse in addition to the intraocular pressure can predict the presence of carotid artery stenosis and indicate the need for further investigation. If a tonometer capable of measuring the pulse amplitude was used routinely in ophthalmic examinations, it would provide a useful screening test for the early diagnosis and treatment of carotid artery disease and might thereby reduce the frequency of strokes.