With oculoplethysmography, conclusions are drawn regarding the state of internal carotid artery disease by measurements based upon pressure and flow in the eye, a location far removed from the site of the disease. Thus, many potential variables including ocular disease, vessel wall properties, intracranial atherosclerosis and collateral flow may affect the results. Although oculoplethysmography was quite accurate in detecting occlusion of the internal carotid artery, the identification of a high grade stenosis was much less precise. Furthermore, it could not distinguish between stenosis and occlusion, making angiography necessary for accurate diagnosis. In this study, oculoplethysmography, either alone or in combination with carotid phonoangiography, was not of sufficient accuracy to recommend its use as part of a noninvasive evaluation of carotid artery occlusive disease.