Many patients with carotid artery disease experience a diversity of ocular symptoms (Table). Thus, the ophthalmologist (1) is often the first physician to see the patient or (2) is asked to act as a consultant to identify structural disease, to confirm or to exclude the presence of retinal emboli, or to perform noninvasive tests reflecting the patency of the carotid circulation. During the past decade, a number of techniques for the diagnosis of carotid artery disease have been developed. There has been a concomitant increase in the number of endarterectomies performed (15000 in 1971 to 103 000 in 1984)2on both symptomatic and asymptomatic patients. This rise has occurred despite little evidence to support the efficacy of the procedure.3-5The majority of endarterectomies fall into the category of prophylactic surgery, in which the patient can be either asymptomatic (ie, patients with neck bruits revealed at routine physical examination)