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Presentation type	E-poster
Title	Reduced conjunctival blood flow: a new clinical sign for the diagnosis of ocular ischemic syndrome

Purpose	To report a case of ocular ischemic syndrome in a patient with non-proliferative diabetic retinopathy, in which reduced conjunctival blood flow observed at slit-lamp examination unveiled a diagnosis of severe bilateral internal carotid artery stenosis guiding prompt ophthalmologic and systemic management
Methods	A 60-year-old man was referred for cataract surgery with bilateral visual acuity of 20/40. Fundus examination revealed bilateral mid-peripheral dot hemorrhages and temporal ghost vessels in the right eye without neovascularization. Systematic anterior segment examination revealed significantly reduced conjunctival blood flow in both eyes particularly visible under 40× slit-lamp magnification. Ultrawidefield fluorescein angiography confirmed the ocular ischemic syndrome, showing a prolonged arm-to-retina circulation time of 29 seconds, broad areas of capillary non-perfusion, and diffuse capillaropathy. Carotid Doppler ultrasonography showed bilateral internal carotid artery stenosis of up to 90%.
Results	Urgent bilateral panretinal photocoagulation was performed (3 sessions per eye), and the patient was referred for carotid endarterectomy and antiplatelet therapy. Cataract surgery was performed 12 months later. At 24-month follow-up, visual acuity was 20/25, intraocular pressure was 13 mmHg, and no neovascular complications or cardiovascular events had occurred.
Conclusion	Reduced conjunctival blood flow, easily assessed at the slit lamp, is an underappreciated but clinically meaningful sign of anterior segment ischemia in ocular ischemic syndrome. Its systematic evaluation may facilitate earlier diagnosis and life-saving vascular intervention in patients with atherosclerotic risk factors.
Conflict of interest	No

Authors 1

Last name	NAJIB
Initials	A
Department	University Hospital of Rouen
City	Rouen, France

Authors 2

Last name	Rakic Natacha
Initials	NR
Department	University Hospital of Liege
City	Liege