Idiopathic ischemic syndromes of the retina and optic nerve and their carotid origin.

Most eye problems referred to vascular surgeons for workup of carotid disease are either transient (amaurosis fugax) or partial (retinal branch artery occlusion) visual loss. Patients with more severe total infarcts of the retina (central retinal artery occlusion) or of the head of the optic nerve ("ischemic optic neuropathy") are seldom suspected of carotid disease and, in the latter case, are generally labeled idiopathic. An explanation for the difference in attitude towards these conditions is suggested. A prescribed carotid etiology for these various ischemic syndromes of the eye and optic nerve was explored in a study of 20 consecutive patients who had acute ischemic eye/optic nerve problems. Special visualization of the neck, orbital, and retinal vasculature was obtained. Sixty percent had ipsilateral and 50% had contralateral carotid artery disease. The ophthalmic artery and the posterior ciliary arteries showed intrinsic lesions each in 25% of cases. Our pilot study concludes that there is strong evidence that most of these ischemic eye syndromes are related to carotid artery disease, which is found in the majority of patients. In a minority of them ischemic problems may be due to arteritis or to intrinsic disease of the ophthalmic artery. A more cohesive approach to the study and treatment of these different entities is supported by the suggestion of a common etiology for most of them. Close collaboration with ophthalmologists will be needed to improve the present management of these eye conditions.