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This early stage of chronic ocular ischemia, often referred to as venous stasis retinopathy (VSR), may remain completely asymptomatic. Progression of the disease may lead to the clinical syndrome of chronic ocular ischemia with progressive visual loss through cotton wool spots; edema of the optic disc and macula; neovascularization of the optic disc, retina, and iris; and finally an uveitislike syndrome and neovascular glaucoma. This may be accompanied by pain around the eye.

It is unclear why only some patients with carotid occlusive disease develop chronic ocular ischemia. In patients with carotid artery occlusive disease, collateral blood flow via branches of the external carotid artery may result in reversal of flow in the ophthalmic artery (OphthA) to sustain cerebral blood flow, most likely at the expense of blood flow to the eye. If this "steal" phenomenon plays a role, one would expect VSR to develop more often in patients with a low flow state of the brain than in patients without compromised cerebral blood flow.