AIM: To report a case of bilateral ocular ischemic syndrome(OIS) with bilateral common carotid artery complete occlusion in a patient after long-term radiotherapy for nasopharyngeal carcinoma. METHODS: Interventional case report. A 57-year-old man presented with a 6-month history of amaurosis fugax in his left eye and ocular and periorbital pain, diagnosed with bilateral OIS. Bilateral panretinal photocoagulation (PRP),cataract surgery, carotid endarterectomy and an Ahmed valve implant were performed consecutively. RESULTS: After PRP and uneventful cataract phacoe- mulsification administrated, the conditions of bilateral eyes were stabilized. However after bilateral carotid endarterectomy, the intraocular pressure(IOP) was increased，accompanied by the visual acuity reduced to counting fingers at six inches. CONCLUSION: The management of bilateral OIS with bilateral common carotid arteries complete occlusion after long-term radiotherapy for nasopharyngeal carcinoma is frustrating and the prognosis for vision is poor.