Background: A 74 years old lady presented with bilateral sudden deterioration of vision over a period of 3 weeks. She is a known diabetic and hypertensive for the past 25 years. The patient denied associated neurological symptoms. The patient underwent a comprehensive non-invasive neuroimaging and retinal imaging. Case Presentation: The case study is about right sided occipital lobe infarction and right sided internal carotid artery stenosis with complete right ophthalmic artery occlusion resulted in right Ocular ischemic syndrome (OIS). Ocular findings showed normal swinging light reflex. Right eye showed rubiosis iridis, neovascularization of the disc. Left eye showed moderate non-proliferative diabetic retinopathy. There was lack of cerebellar and/or cortical constitutional symptoms.
Magnetic resonance angiography (MRA) imaging showed compromised right side internal carotid system and complete occlusion of the right  ophthalmic artery. Magnetic resonance imaging (MRI) showed as well isolated right sided occipital lobe infarction. The patient received neurological and ocular treatment.
 Conclusion: Painless sudden bilateral visual disturbance in an elderly individual should draw the clinician attention to possible cortical etiology  inspite the absence of neurological symptoms. Non-invasive imaging techniques had been shown to be effective in the evaluation of symptomatic Ocular ischemic syndrome (OIS), which should be considered if the gold standards imaging techniques are relatively or absolutely contraindicated.