We investigated the demographics, presentation, and outcome of patients undergoing cerebrovascular reconstruction for chronic ocular ischemia (COI) at a single institution through a review of 17 patients over a 9-year period. A total of 558 extracranial cerebrovascular reconstructions were performed during the period of study. Seventeen patients (3%) suffered symptoms of COI. There were 19 symptomatic eyes and 15 asymptomatic eyes. Two patients suffered bilateral symptoms. Eighteen (95%) symptomatic eyes experienced rapidly degenerating global visual acuity, and one suffered bright-light amaurosis. Concomitant ocular pathology was present in 10 (59%) patients, consisting of glaucoma (n = 4), cataracts (n = 4), diabetic retinopathy (n = 3), and macular degeneration (n = 1). Symptomatic eyes were found to have significantly worse ipsilateral internal carotid artery (p = 0.004), external carotid artery (p = 0.002), aortic arch branch disease (p = 0.04), and vertebral artery disease (p = 0.04). All 17 reconstructions treated ipsilateral disease. Twelve patients (70.6%) had significant bilateral disease at the time of operation. Three patients underwent staged contralateral reconstruction. Following revascularization, subjective visual improvement or stabilization occurred in 16 patients (94%). A single patient worsened after developing acute narrow angle glaucoma in the perioperative period. Worse cerebrovascular disease is present ipsilateral to symptomatic eyes. When revascularization is performed, arrest of progression or improvement of symptoms occurs in most patients.