Aim. To compare the effectiveness (neurological status and visual function) of surgical and conservative treatment of patients with atherosclerotic carotid stenosis and chronic ocular ischemic syndrome (OIS). Material and methods. Groups of surgical and medical treatment consisted of 43 and 33 patients respectively. Survey included visual acuity (VA), autorefractometry, direct and indirect ophthalmoscopy under mydriasis, computerized static perimetry, evaluation of functional state of optic nerve (ON) with determination of threshold electric sensitivity and lability of ON, ophthalmic and carotid arteries sonography. Examination was performed at baseline, one month and one year after surgery or conservative treatment. Results. In patients with chronic ischemic retinopathy there was improvement of visual acuity on 0.1 unit and more (group1/group 2; p=0.0045), significant visual fields enlargement in group 1 (p=0.0446). In chronic ischemic neuropathy visual acuity was improved on 0.1 unit and more (group 1/group 2; p=0.1855), visual fields enlargement (group 1/group 2; p=0.008). The dynamics of neurological status in patients with stenosis and chronic OIS was multidirectional unreliable. Asymptomatic/symptomatic patients ratio improved from 27/16 at baseline to 35/8 in one year after CEA (p=0.0924) and deterioration in case of medical treatment - 22/11 vs. 11/22 (p=0.0138). Comparison showed significant differences between both groups (35/8 vs. 11/22) (p=0.0001).