Background: This study aims to investigate ocular ischemia in patients who were candidates for carotid endarterectomy (CEA) and postoperative flow changes in orbital arteries, and demonstrate the impact of these flow changes on the eye and ocular ischemia. 

Methods: Thirty patients (23 males, 7 females; mean age 68.1 +/- 7.61 years; range 47 to 82 years) who were planned to undergo CEA due to critical carotid artery stenosis between November 2011 and May 2012 were analyzed prospectively. Fundus examination, visual acuity measurement and intra ocular pressure measurement were performed, and color fundus images were taken with fundoscopy preoperatively. Central retinal artery (CRA) and ophthalmic artery (OA) flows were measured with orbital color Doppler ultrasound (RDUS). The same procedures were repeated postoperatively, and findings were compared. These flow findings were compared with findings of a control group which was composed of 20 volunteers (14 males; 6 females, mean age 47.5 +/- 9.9 years) without carotid artery stenosis. 

Results: Ten out of 30 patients (33.3%) had initial findings of ocular ischemic syndrome (OIS). Pre-CEA retinal artery peak systolic velocity (PSV) values of patients with initial findings of OIS were significantly lower compared to values of patients without initial findings of OIS and the control group. Significantly increased post-CEA retinal artery PSV values were detected for all these patients. While increased visual acuity was detected in five of the 10 patients (50%) with initial findings of OIS, there was no change in five patients. 

Conclusion: Severe carotid artery stenosis may lead to ocular ischemia, retinal embolus, and OIS. These pathologies can be demonstrated via orbital RDUS and retinal photography. Carotid endarterectomy may regulate the reduced ocular blood flow, and support ocular healing.