Ocular ischemic syndrome is a rare, blinding condition that usually presents rather late. This occurs mainly due to stenosis or occlusion of the carotid artery which supplies the ocular structures. Bilateral involvement may occur in one in five cases but may be asymmetrical. We report a case of a 72-year-old gentleman with bilateral ocular ischemic syndrome secondary to left common carotid artery total occlusion and severe right proximal internal carotid artery stenosis in a patient who is an active smoker with chronic tophaceous gout. His vision remained stable after a year of follow-up, with the main emphasis on optimizing his medical condition and smoking cessation.
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