INTRODUCTION Isolated monocular ischaemic events are thought to be low risk for stroke recurrence. In the presence of carotid
stenosis however, the risks should not be treated similarly and surgical intervention should be considered at an early stage.
The aim of this study was to determine the vascular risk profile and stroke recurrence in patients with ischaemic monocular
visual loss.
METHODS AND METHODS Consecutive records for all patients with monocular ischaemia were reviewed from January 2014 to
October 2016. Stroke, transient ischaemic attack or monocular ischaemia recurrence within 90 days were recorded. Carotid
stenosis was assessed with duplex ultrasound, computed tomography or magnetic resonance angiography.
RESULTS In total, 400 patients presented with monocular ischaemia; 391 had carotid imaging (97.8%). Causality was symptomatic carotid stenosis ≥ 50% in 53 (13.6%), including carotid stenosis ≥ 70% in 31 (7.9%). Patients with permanent visual
loss (n = 131) were more likely to have significant stenosis compared with patients with transient visual loss (n = 260), 19.8%
compared with 10.4% (P = 0.012). Recurrent stroke, transient ischaemic attack or monocular ischaemia within 90 days after
presentation occurred in three patients (5.7%) in the carotid stenosis group, compared to three (0.9%) who did not have stenosis (P = 0.035). Age, male sex and hypertension were associated with carotid stenosis but hypercholesterolaemia, diabetes and
smoking were not.
CONCLUSIONS Carotid stenosis ≥ 50% is present in patients with ocular ischaemia in approximately 20% of those with persistent visual loss and in 10% with transient visual loss. Those with carotid stenosis have a higher risk of stroke recurrence and
should be considered urgent surgical intervention as other forms of stroke