AIM: To investigate the correlation of ischemic ophthalmopathy (IO) with lacunar infarction (LI), an ischemic lesions in the cerebrovascular system. METHODS: Totally 204 cases of IO without any nervous system symptom and previously diagnosed LI served as the observational group. All 204 cases without IO, nervous system symptoms and previous LI served as the control group. Age and sex between the two groups matched well. LI was diagnosed by magnetic resonance imaging (MRI) and the results of the two groups were statistically analyzed and compared. RESULTS: IO included 174 eyes of 156 patients with non-arteritis anterior ischemic optic neuropathy (NAION), 42 eyes of 36 patients with central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO) and 12 eyes of 12 patients with ocular ischemia syndrome (OIS).The detection rate of LI (72.54%) in IO group was obviously higher than that (15.68%) in the control group (P<0.001). IO was positively correlated with LI (r=0.573, P<0.05). In addition, most infarction sites located in the basal ganglia (67.57%), which were not the vital areas of cerebrum and not easy to be found due to their small size. The majority of those first visited IO patients (72.54%) without nervous system symptom and previously diagnosed LI had already suffered from LI. CONCLUSION: According to our studies, there is a positive correlation between IO and LI. IO can be used as an important predictor for the present of LI, especially obvious signs of the patient.