Doppler examination of the periorbital arteries adds valuable hemodynamic information in carotid artery disease.

The periorbital flow direction and internal carotid artery (ICA) angiogram were compared to the ICA pressure gradient across the stenosis and the distal ICA pressure in 51 patients subjected to carotid endarterectomy. All 17 patients with inverted periorbital flow had stenoses exceeding 50%. The remaining 16 patients with the same degree of stenosis had antegrade flow, which was also observed in all patients with less than 50% stenosis. In 16 of 17 patients with inverted periorbital flow, the mean pressure gradient exceeded 10 mmHg, whereas 33 of 34 patients with antegrade flow had gradients of 12 mmHg or less. For diagnostic purpose, the periorbital Doppler test is inferior to direct Doppler examination or angiography. However, as an adjunct to direct techniques, patients can be classified into 3 groups: Patients with less than 50% stenosis, Patients with 50% stenosis or more and good collaterals and, Patients with 50% stenosis or more and insufficient collaterals.