Neovascular glaucoma in systemic occlusive vascular disease

A 58-year-old woman was seen with a red inflamed right eye with rubeosis iridis and neovascular glaucoma with closure of the angle. There was no evidence of the diabetes and no evidence of occlusion of the central retinal vein. Physical examination was normal except for an absent carotid pulse on the right side, a carotid bruit on the left side, and absence of the pulse in all extremities. Further evaluation revealed severe arteriosclerosis involving many major branches of the aorta, including both carotid arteries. This patient had neovascular glaucoma as the only presenting sign of severely arteriosclerotic stenosis of both carotid arteries. This case demonstrates the need for emphasis on this rare but occult life-threatening cause of neovascular glaucoma. Ophthalmologists should be alert to the possible presence of carotid occlusive disease as a causative factor when cases of neovascular glaucoma are encountered.