ObjectiveTo observe the prevalence of ocular ischemic appearance (OIA) associated with carotid artery stenosis, and to explore the correlation between the ocular ischemic appearance and the carotid stenosis degree and location. MethodsA total of 132 patients with carotid artery stenosis diagnosed by color Doppler ultrasound and CT angiography were enrolled in this prospective study. The carotid stenosis degree and location were identified. The ophthalmic symptoms was inquired. The corrected vision, diopter, intraocular pressure, slit lamp microscope and fundus examination were used to determine if OIA exists. The correlation between the OIA and the carotid stenosis degree and location were analyzed. The carotid stenosis degree was divided into 4 types: mild (≤50%), moderate (<50% but ≤75%), severe (<75% but ≤99%) and occlusion (100%). ResultsThe distribution of carotid stenosis degree as follow: mild in 16 patients (12.1%), moderate in 46 patients (34.8%), severe in 50 patients (37.9%) and occlusion in 20 patients (15.2%). The stenosis located in the external carotid artery in 21 patients (15.9%), in internal carotid artery in 46 patients (34.8%), in crotch of extracranial internal carotid artery in 55 patients (41.7%), and in common carotid artery in 10 patients (7.6%). There were 54 patients (40.9%) with ocular ischemic diseases, which including retinal arterial obstruction (5 patients, 9.2%), retina change of venous stasis (13 patients, 24.1%), neovascular glaucoma (7 patients, 13.0%), ischemic optic neuropathy (19 patients, 35.2%), ocular ischemia syndrome (10 patients, 18.5%). The ophthalmic symptoms included transient amaurosis, decreased visual acuity, eye and periorbital pain, retinal hemorrhage and exudation, diplopia, rubeosis iridis and increased intraocular pressure. There was highly positive correlation between the carotid stenosis degree and OIA (r=0.287, P=0.018). There was no correlation between the carotid stenosis location and OIA (P>0.05). Conclusion40.9% carotid stenosis patients has OIA. There is relationship between the carotid stenosis degree and OIA, but carotid stenosis location showed no correlation with OIA.