Bilateral acute Ocular Ischemic Syndrome following head and neck radiation

Previous literature has established a clear correlation between radiation therapy (RT) to the head and neck leading to aggressive atherosclerosis of the carotid arteries and subsequent increased risk for ischemic stroke. Stenosis of carotid arteries can lead to Ocular Ischemic syndrome (OIS). We present a case of acute bilateral OIS following head and neck RT for left tonsillar squamous cell carcinoma (SCC) in a 64 year-old Caucasian male. Routine large vessel cerebrovascular screening following head and neck radiotherapy should be considered as a means of potentially mitigating future stroke risk through initiation of medical therapy and interventional modalities as a means of primary prevention. In addition to large vessel screening by carotid duplex ultrasound, it may also be pertinent to consider further evaluation with more detailed medium and small vessel imaging through CT angiography in select cases.