Anatomy, Head and Neck, Ophthalmic Arteries


Article Author:
Benjamin Bird


Article Editor:
Stanislaw Stawicki


Editors In Chief:
Michael Labanowski


Managing Editors:
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Frank Smeeks
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Radia Jamil
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Pritesh Sheth
Hassam Zulfiqar
Steve Bhimji
John Shell
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Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Hajira Basit
Phillip Hynes
Kavin Sugumar


Updated:
2/8/2019 8:55:06 AM

Introduction

The ophthalmic artery is the first branch of the internal carotid artery. It comes off just distal to the cavernous sinus. The ophthalmic artery gives off many branches, which supply the orbit, meninges, face, and upper nose. When the ophthalmic artery is occluded, it can compromise vision. The ophthalmic artery comes off the internal carotid artery on the medial side of the anterior clinoid process and traverses anteriorly through the optic canal and just lateral to the optic nerve.[1][2][3]

The following are branches of the ophthalmic artery:

  1. The first branch of the ophthalmic artery is the central retinal artery that runs in the dura mater of the optic nerve. It then moves further along and supplies the inner layers of the retina.
  2. The second and the largest branch of the ophthalmic artery is the lacrimal artery. It also enters the orbit and traverses along the superior edge of the lateral rectus muscle. It supplies the eyelids, lacrimal gland, and conjunctiva.
  3. The ophthalmic artery gives off several posterior ciliary arteries that pass through the sclera and supply the posterior uveal tract. Because the posterior ciliary vessels are end vessels, sudden occlusion can produce infarction in the region of the choroid.
  4. The ophthalmic artery also gives off the inferior and superior muscular vessels that supply the extraocular muscles. The supraorbital artery is also a branch of the ophthalmic artery and passes through the supraorbital foramen to supply the skin of the forehead and Levator palpebrae muscle.
  5. Other branches of the ophthalmic artery include the ethmoid arteries, medial palpebral vessels, and terminal branches. 

When there is occlusion of the ophthalmic artery, it can result in an ischemic syndrome. Amaurosis fugax is a condition associated with temporary, painless loss of vision due to either an embolic phenomenon or hypoperfusion. Emboli to the ophthalmic artery usually originate from the carotid artery bifurcation. One may visualize Hollenhorst bodies (a.k.a., Eickenhorst plaques) in the retina during fundoscopic evaluation. When there is a sudden, painless loss of vision in one eye, it is recommended that one obtain a duplex ultrasound of the neck to assess the carotid artery for atherosclerotic plaques.[4][5][6]

Embryology

Despite tremendous accumulated knowledge of the vascular anatomy, the understanding of the arterial development in the human embryo from the branchial to the postbranchial stage is still relatively poor. Key considerations in the area of blood supply to the orbit include the presence of both internal and external carotid contributions, with this dual "circuit" arrangement structured on embryological origins. In the majority of cases, communication between the middle meningeal artery and the ophthalmic artery is present, passing through the superior orbital fissure in most cases. Less commonly, an additional meningo-orbital foramen (foramen of Hyrtl) may be present lateral to the superior orbital fissure, with the connecting branch known as the sphenoidal artery, recurrent meningeal artery, or orbital branch of the middle meningeal branch.

Among clinically relevant, practical anatomy, important anomalies pertinent to the ophthalmic artery warrant being mentioned at this juncture. Dilenge and Ascherl (1980) reported on 42 anomalies of the ophthalmic and middle meningeal arteries. In that study, approximately 2.4% of anomalies involve the separation of ocular branches of ophthalmic artery from extraocular intraorbital branches. The same figure (2.4%) has been noted for the presence of accessory ophthalmic artery. In approximately 7.1% of cases, the ophthalmic artery arises from the middle meningeal artery. Approximately 17% of anomalies involve the ophthalmic artery arising from an extradural portion of the carotid siphon. The most common anomaly of this vascular circuit (about 40% of cases) is the middle meningeal artery arising from ophthalmic artery.[7][8]

In summary, the ophthalmic artery can arise from the middle meningeal artery, middle cerebral artery, or the posterior communicating artery. In addition, the middle meningeal artery can arise from the ophthalmic artery. Furthermore, the cavernous origin of the ophthalmic artery has been reported. Finally, the presence of persistent stapedial artery has been well described by neurovascular anatomy experts. All of the above anatomic variations must be recognized at the time of invasive procedures involving related blood supply to this critically important body region. For example, embolization of a tumor supplied by the external carotid artery may result in loss of vision if the eye depends on the anatomically anomalous routing of blood to maintain retinal perfusion.

Nerves

The ophthalmic artery is intimately associated with the optic nerve (e.g., Cranial Nerve II). Additional important neurovascular structures in proximity to the ophthalmic artery include the following structures:

Nerves

  • Lacrimal Nerve (Cranial Nerve Va)
  • Frontal Nerve (Cranial Nerve Va)
  • Trochlear Nerve (Cranial Nerve IV)
  • Superior Division of the Oculomotor Nerve (Cranial Nerve IIIs)
  • Nasociliary Nerve (Cranial Nerve Va)
  • Inferior Division of the Oculomotor Nerve (Cranial Nerve IIIi)
  • Abducens Nerve (Cranial Nerve VI)
  • Ganglionic Branches (from Pterygopalatine Ganglion to Maxillary Nerve)
  • Infraorbital Nerve (Cranial Nerve Vb)
  • Zygomatic Nerve (Cranial Nerve Vb)

Veins

  • Superior Ophthalmic Vein
  • Inferior Ophthalmic Veins
  • Infraorbital Vein

Arteries

  • Infraorbital Artery

Muscles

As mentioned previously, the ophthalmic artery continues medially as the superior and inferior muscular branches. These important branch vessels originate either directly from the ophthalmic artery or from a separate trunk that subsequently divides into the superior and inferior branches. These branches provide blood supply to the extraocular muscles.

Clinical Significance

Additional important considerations regarding the ophthalmic artery include the following arterial branches:

  • Ethmoidal Arteries = The ophthalmic artery turns anteriorly after reaching the medial orbital wall. The anterior ethmoidal artery enters the nose after traversing the anterior ethmoidal canal and brings blood supply to the anterior/middle ethmoidal and the frontal sinuses. This branch subsequently enters the cranium and supplies blood to the meninges. The posterior ethmoidal artery enters the nose through the posterior ethmoidal canal. It provides the blood supply for the posterior ethmoidal sinuses. It also subsequently enters the cranium and supplies the meninges.
  • Medial Palpebral Arteries = The ophthalmic artery courses anteriorly toward the trochlea. Here, the superior and inferior medial palpebral arteries originate. This is the blood supply to the eyelids.
  • The Supraorbital Artery = Branches from the ophthalmic artery during its course over the optic nerve, passes anteriorly along the medial border of the levator palpebrae and superior rectus, and then through the supraorbital foramen to provide blood supply to the muscles and skin of the forehead.
  • The Terminal Branches = There are two terminal branches of the ophthalmic artery. The supratrochlear (frontal) artery and the dorsal nasal artery. Both of these vessels exit the orbit medially and supply the forehead and scalp.

Other Issues

It may be helpful for those studying the anatomy of the ophthalmic artery to utilize the mnemonic "DR MCLESSI," which stands for:

  • D = Dorsal Nasal Artery
  • R = [Central] Retinal Artery
  • M = Muscular Artery
  • C = Ciliary Arteries [Long / Short / Anterior]
  • L = Lacrimal Artery
  • E = Ethmoidal Arteries [Anterior / Posterior]
  • S = Supraorbital Artery
  • S = Supratrochlear Artery [Frontal]
  • I = Internal Palpebral Artery

Because the mnemonic does not represent the correct order of ophthalmic artery branches, the reader should note that the first and second last branches of the mnemonic are the terminal branches, both exiting the orbit medially to supply the forehead/scalp.


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Anatomy, Head and Neck, Ophthalmic Arteries - Questions

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A 64-year-old male with a history of atrial fibrillation presents to the clinic with a chief complaint of left-sided persistent painless monocular vision loss that began in the morning prior to presentation. His vital signs are all within normal limits. His cardiovascular exam is significant for irregularly irregular heart rhythm, and an ophthalmic examination shows a pale retina with a cherry-red spot, along with the embolus responsible for the patient's symptoms. Which of the following correctly identifies the vascular route this embolus took to reach its destination?



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An 82-year-old male with a history significant for coronary artery disease, hypertension, hyperlipidemia, and diabetes mellitus is admitted to the hospital for stroke-like symptoms. During his stay, he begins to develop pain in his right eye, described as an ache that extends from the eye itself up to the eyebrow on the same side. His vision declines from 20/40 to counting fingers at 2 feet over the course of a week. Ophthalmic examination reveals iris neovascularization and retinal hemorrhages. Blockage of which of the following arteries likely accounts for his symptoms?



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A 68-year-old male with a history of hyperlipidemia presents to the clinic with a chief complaint of left-sided persistent painless monocular vision loss that began in the morning prior to presentation. His vital signs include a blood pressure of 155/95mmHg, with all others being within normal limits. His cardiovascular exam is significant for irregularly irregular heart rhythm, and an ophthalmic examination shows a pale retina, with no other findings. Imaging studies obtained in a previous hospital stay 5 years ago showed mild stenosis of his left common carotid and ophthalmic arteries. Along with carotid ultrasonography and fluorescein studies, which is the preferred imaging modality to evaluate vascular status in this patient's case?



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A 72-year-old male with a history significant for hypertension, coronary artery disease, and hyperlipidemia presents to the clinic with a chief complaint of right-sided vision loss and a dull ache of the right eye which woke him from sleep early this morning. His ophthalmic examination is significant for rubeosis, cell and flare, retinal neovascularization and retinal hemorrhage. Imaging studies are obtained, which show severe occlusion of the first branch of the right internal carotid artery. This artery contributes to the blood supply of which of the following cranial structures?



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A 65-year-old male was walking home when he suddenly lost vision in his left eye. In the emergency department, he claims that it felt as if a curtain came over the eye for 10 seconds. He is alert with stable vital signs and no neurological deficits. The patient was seen by the neurologist who states that the patient most likely had an embolic phenomenon via the first branch of the internal carotid artery. The embolus was most likely transiently lodged in which blood vessel?



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Anatomy, Head and Neck, Ophthalmic Arteries - References

References

Cotofana S,Lachman N, Arteries of the Face and Their Relevance for Minimally Invasive Facial Procedures: An Anatomical Review. Plastic and reconstructive surgery. 2019 Feb;     [PubMed]
Tayebi Meybodi A,Borba Moreira L,Lawton MT,Eschbacher JM,Belykh EG,Felicella MM,Preul MC, Interdural course of the ophthalmic artery in the optic canal. Journal of neurosurgery. 2019 Jan 4;     [PubMed]
Duma SR,Ghattas S,Chang FCF, Internal Carotid Artery Occlusion Causing Acute Cranial Neuropathies. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2019 Jan 9;     [PubMed]
Kuybu O,Dossani RH, Cavernous Sinus, Syndromes 2018 Jan;     [PubMed]
Shumway CL,Wade M, Anatomy, Head and Neck, Orbit Bones 2018 Jan;     [PubMed]
Zhang P,Wang Z,Yu FX,Lv H,Liu XH,Feng WH,Ma J,Yang ZH,Wang ZC, The clinical presentation and collateral pathway development of congenital absence of the internal carotid artery. Journal of vascular surgery. 2018 Oct;     [PubMed]
Melé MV,Puigdellívol-Sánchez A,Mavar-Haramija M,Juanes-Méndez JA,Román LS,De Notaris M,Catapano G,Prats-Galino A, Review of the main surgical and angiographic-oriented classifications of the course of the internal carotid artery through a novel interactive 3D model. Neurosurgical review. 2018 Jul 26;     [PubMed]
von Arx TVA,Tamura K,Yukiya O,Lozanoff S, The Face – A Vascular Perspective. A literature review Swiss dental journal. 2018 May 14;     [PubMed]

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