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In 102 patients with angiographically proven occlusive carotid artery disease of 60–100% diameter reduction, Doppler ophthalmic artery pressure and blood flow direction were recorded by the recently developed ophthalmomanometry-Doppler technique. Among these 102 patients, 50 presented with complete carotid artery occlusions and 52 with carotid artery diameter stenoses of ≤60%. Mean±SD Doppler ophthalmic artery pressure was 69 ±15 mm Hg ipsilateral to the occlusion and 86 ±18 mm Hg ipsilateral to a stenosis of the carotid artery (/> < 0.001). The mean±SD Doppler ophthalmic pressure index (ratio of the ophthalmic artery to systemic blood pressure) was lower ipsilateral to the occlusion (0.46 ±0.08) than ipsilateral to a carotid artery stenosis (0.54±0.08;/> < 0.001); in both, the index was clearly diminished compared with normal values (0.68 ±0.04; p < 0.001). It is concluded that the intracranial hemodynamic consequences in the patients with occlusion are on average more profound than in the patients with stenosis. In carotid artery occlusions, the mean±SD ipsilateral ophthalmic pressure index was 0.46 ±0.06 for antegrade and 0.46 ±0.09 for retrograde ophthalmic artery blood flow. In carotid artery stenoses, the mean±SD ipsilateral ophthalmic pressure index was 0.55 ±0.07 for antegrade and 0.48 ±0.06 for retrograde ophthalmic artery blood flow (/? < 0.01). These results indicate that in carotid stenoses the collateral capacity of the ophthalmic artery is insufficient compared with intracranial collaterals, while in carotid occlusions the blood flow direction in the ophthalmic artery does not predict intracranial hemodynamic compensation.