Carotid artery ectasia coexistent with primary open angle glaucoma

A 60-year-old smoker presented with high intraocular pressure in the right eye with a right afferent pupil defect and visual field suggestive of prima ry open angle glaucoma in the right eye only, when an examination 2 years e arlier had revealed no hint of ocular pathology. Radiological investigation s demonstrated prominent ectasia of the internal carotid arteries extending into the proximal middle cerebral arteries. The changes in the carotids ex tended throughout the cavernous sinus regions, encroached on the under surf ace of the optic chiasm and were closely related to the internal aspects of both optic canals. In primary open angle glaucoma management, neural imagi ng is not normally recommended; however, neural imaging investigations shou ld be considered if the presentation is not typical of a chronic bilateral optic neuropathy.