The records of 43 consecutive patients (51 eyes) with the ocular ischemic syndrome (ocular symptoms and signs attributable to severe carotid artery obstruction) were studied in a retrospective fashion. Men comprised 67% of the group and the mean age at presentation was 64.5 years. In the anterior segment, neovascularization of the iris was observed in 66% of eyes and iritis was noted in 18%. Posterior segment signs included narrowed retinal arteries and dilated, but not tortuous, retinal veins. Mid-peripheral retinal hemorrhages were seen in 80% of eyes, posterior segment neovascularization was observed in 37%, and a cherry red spot was noted in 12%. Fluorescein angiography commonly revealed delayed choroidal and retinal filling, while electroretinography generally demonstrated a reduction in the amplitude of both the a- and b-waves.