Ocular ischemic syndrome: a rare bilateral presentation in a hypertensive patient – a case report

Background: Ocular Ischemic Syndrome (OIS) is a rare, vision-threatening disorder resulting from chronic hypoperfusion of the ocular tissues due to carotid artery occlusive disease. It may present with a combination of anterior and posterior segment ischemic changes and often reflects underlying systemic vascular compromise. Case Presentation: A 59-year-old male with a two-year history of hypertension presented with gradual blurring of vision in both eyes for three years. No history of ocular trauma or prior eye disease was reported. Ocular examination revealed best-corrected visual acuity (BCVA) of 6/24 in both eyes with compound hyperopic astigmatism and presbyopia. Slit-lamp and fundus evaluation showed retinal hemorrhages and cotton-wool spots bilaterally, suggestive of ocular ischemic changes. Intraocular pressures were within normal limits. Optical Coherence Tomography (OCT) of the macula revealed ischemic retinal changes. Management: The patient received intravitreal anti-VEGF (Avastin) injections in both eyes, followed by panretinal photocoagulation (PRP) after the first injection. Systemic evaluation for carotid artery stenosis and cardiovascular risk factors was advised in collaboration with a neurologist and a physician. Conclusion: Early recognition of OIS is crucial as it may be the first clinical manifestation of severe carotid artery disease. Timely ophthalmic and systemic interventions can prevent irreversible visual loss and life-threatening cerebrovascular events.