Ocular pneumoplethysmography was performed before and after 1,737 carotid endarterectomies, 82% of which were performed for carotid lesions of hemodynamic consequence. Preoperative ocular hypoperfusion without ischemia was associated with at least transient postoperative ocular hyperemia. A difference in ocular volume change per minute of 14.0%, female greater than male, was explained by sex differences in heart rate, brachial pulse pressure and eye size. These observations may have a direct application in the management of diabetic retinopathy with panretinal photocoagulation.