The long ciliary nerves are branches of the nasociliary nerve (from V1) that pass from the optic canal forward within the orbit to pierce the sclera posterior to the ciliary body and run anteriorly between the sclera and choroid to reach the ciliary body, iris, and cornea. They carry sensory fibres from the cornea and iris, and sympathetic fibres to the dilator pupillae muscle (bypassing the ciliary ganglion).
The long ciliary nerves are the anatomical basis of the Hutchinson sign in herpes zoster ophthalmicus: the nasociliary nerve (parent of the long ciliary nerves) supplies both the nasal tip (via the infratrochlear nerve) and the cornea (via the long ciliary nerves), so nasal tip vesicles indicate involvement of the nasociliary nerve and predict corneal (long ciliary nerve) involvement. Retrobulbar anaesthesia blocks the long ciliary nerves at the posterior globe for intraocular surgery corneal and iris anaesthesia. The long ciliary nerves carry the sympathetic fibres responsible for cocaine eye drop testing in Horner syndrome.
Herpes zoster involving the nasociliary nerve produces virus in both the nasal skin (infratrochlear branch) and the cornea (long ciliary nerve branches); the Hutchinson sign of nasal tip vesicles predicts 76% risk of corneal involvement requiring antiviral treatment and ophthalmological examination for corneal dendrites and anterior uveitis.
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