Reversal of blood flow in an ophthalmic artery as determined by directional Doppler ultrasound (OSM) was present in nine (3%) of 310 patients over 50 years of age who did not have complaints, diagnoses or examination findings suggesting disease of the central nervous system, and was present in nine (12%) of 73 patients with neurological disease selected as technical controls. Twenty-two of the control patients had four-vessel angiography. Five with OSM evidence of reversal of flow had functional occlusion of the appropriate internal carotid artery, and 17 without reversal did not. This study presents evidence that occlusion of an internal carotid artery frequently occurs without producing recognizable clinical dysfunction.