Ocular ischaemic syndrome presenting as deteriorating visual fields in a glaucoma patient

2 August 2023
Summer 2023

Case study: Specialist optometrist Andrew J Morgan FCOptom discusses a case of ocular ischaemic syndrome and its differential diagnoses, central retinal vein occlusion and diabetic retinopathy.


A 71-year-old white male was seen at the hospital glaucoma clinic for follow-up and reported reduced vision in the LE.

Medical and ocular history

The patient had presented to eye casualty a month previously with raised LE IOP and was diagnosed with LE acute angle closure glaucoma. He had subsequently undergone 

bilateral YAG iridotomies. 

General health

  • Type 2 diabetes since 2007.
  • Essential hypertension since 2002.
  • High cholesterol.
  • Heart disease.
  • Stroke in 2020.
  • Smoker.

Relevant family history 

No family history of eye disease.

Clinical examination

Best-corrected visual acuity: RE 6/9; LE 6/45 (NIPH). 

IOP: (Goldmann tonometry at 2.15pm) RE 17 mmHg; LE 28 mmHg.

Visual fields: RE shallow superior nasal step defect; LE widespread loss (superior hemifield > inferior).

Also see table 1.  


Gliclazide, alogliptin, sildenafil, furosemide, clopidogrel, atorvastatin.


Topical medication (g. latanoprost nocte both eyes; g. Cosopt bd LE only) was prescribed to improve IOP control. Given the fundus appearance and the disparity between visual field loss and optic nerve appearance, ocular ischaemic syndrome (OIS) was suspected and fundus fluorescein angiography requested. This showed delayed arterial and venous filling and peripheral ischaemia, confirming the diagnosis of OIS.

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