Case report: We report the case of a 44-year-old woman, with a history of cigarette smoking (60 per day) and hyperthyroidism. She presented a bilateral ocular ischemic syndrome, and a bilateral occlusive carotid artery disease which showed reverse ophthalmic artery flow that resulted in a steal phenomenon, characterized by a shunt to the low resistance intracranial circuits and reduction of blood flow to the eyes.
Discussion: Young patients with severe bilateral occlusive carotid artery disease may be at greater risk of developing ocular ischemic syndrome, while this reverse flow decreases the patient's risk of stroke and death.