Ophthalmologic findings as predictors of carotid artery disease

Vascular events that occur in the brain also occur in the eye, giving rise to different ophthalmologic manifestations that range from amaurosis fugax to complete blindness due to central retinal artery occlusion. The objective of this study was to ascertain the relative frequency and predictive value of ocular findings suggestive of carotid occlusive disease in patients being investigated for carotid endarterectomy. The charts of 366 patients undergoing carotid angiography for evaluation of cerebrovascular or visual symptoms over a 5-year period were reviewed. The presence of eye symptoms, neurologic symptoms, cervical bruits, and ophthalmologic findings on admission was recorded and correlated with the presence of significant carotid artery stenosis (≥ 50%). Positive eye findings included retinal plaques, rubeosis iridis, neovascular glaucoma, venous stasis retinopathy, central and branch retinal artery occlusion, ischemic optic neuropathy, and asymmetric hypertensive retinopathy. Seventy-five patients (21%) presented with amaurosis fugax; 41 patients (11%) were found to have one or more ocular findings consistent with carotid artery disease. All patients with positive eye findings were diagnosed by ophthalmologists, who were consulted in 94 cases. Of these 41 patients, 29 (70.3%) were subsequently shown to have greater than 50% stenosis of the common or internal carotid artery. Ten patients had amaurosis fugax, a carotid bruit, and positive eye findings. All were shown to have a significant carotid stenosis. This study shows that ocular pathology, if diagnosed, is correlated with carotid stenosis, especially if other contributing history and physical findings are also considered.