Ocular ischemic syndrome is caused by chronic insufficiency of the blood supply to the eye as a result of severe bilateral carotid artery stenosis or occlusion. The signs of ocular ischemia syndrome include retinopathy (retinal microaneurysms, hemorrhages, and veindilatation), cataract, iris neovascularization (rubeosis iridis), and neovascular glaucoma. The role of carotid endarterectomy in stabilizing and improving vision in patients with ocular ischemic syndrome is controversial. The authors describe 2 patients with ocular ischemic syndrome and rubeosis who, following carotid endarterectomy, developed an intractable rise of intraocular pressure, which led to visual loss. The presence of rubeosis suggests poor visual prognosis and thus should be considered before a decision is made about carotid endarterectomy.