The Carotid Stump Syndrome and the Eye

Carotid Stump Syndrome
Small blood clots formed at the thrombus in the “stump” of internal carotid artery pass to the brain and eye along the path outlined by the white arrows. Image modified from Baker et al. Cureus 2022 Mar; 14(3): e22746

What is the carotid stump syndrome?

The internal carotid artery is the main artery in the neck that brings blood from the heart to the eye.  Due to hardening of the arteries, the carotid artery may become blocked.  Risk factors include high blood pressure, diabetes, high cholesterol, obesity, and tobacco use.  If the carotid artery becomes completely blocked, there is a dead-end or stump beyond which the blood cannot flow.  Due to lack of blood flow from this blockage, tiny blood clots may form in the carotid artery.  Then, they may find their way to the eye through bypass channels that develop in response to the blocked carotid artery.

What eye symptoms result from the carotid stump syndrome?

When tiny blood clots enter the eye from the carotid artery, they may cause blind spots in the vision. Sometimes, the blind spots are small and may not be noticed by the patient.  At other times, the blind spot may appear like a reddish or black bar or arc in the vision.  In severe cases, the entire vision may black out…either temporarily or permanently. 

How can the eye doctor help?

The symptoms from the carotid stump syndrome may also be caused by many other disorders.  The role of the eye doctor is to determine the cause of the symptoms and determine if they are due to the carotid stump syndrome.  Eye examination and testing is necessary.  There is often no specific treatment needed for the eye condition.  The symptoms frequently improve with time if the underlying condition is treated.    

How is the carotid stump syndrome treated?

Medicines and surgery are used to treat the carotid stump syndrome.  Anti-platelet medications are the mainstay of treatment.  They work by limiting the tendency of the blood to clot.  Surgery may open the blocked carotid artery. 

By Scott E. Pautler, MD

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