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Superior Ophthalmic Vein

vena ophthalmica superior

The superior ophthalmic vein is the dominant venous drainage of the orbit, running from the medial orbit (where it connects with the angular vein and facial vein anteriorly) to exit posteriorly through the superior orbital fissure into the cavernous sinus. It accompanies the ophthalmic artery in the orbit and receives tributaries from the extraocular muscles, the lacrimal gland, the choroid, and the superior vorticose veins.

Region: Head & Skull

Clinical Relevance

Clinical Notes

The superior ophthalmic vein provides the critical communication between the facial venous system and the cavernous sinus, making it the conduit for both septic thrombosis from facial infections and for arterialised blood flow in direct carotid-cavernous fistulae. In carotid-cavernous fistula, arterialized blood refluxes anteriorly through the superior ophthalmic vein, producing pulsating proptosis, chemosis, and an orbital bruit. Endovascular embolisation targets the fistula via the femoral vein, inferior petrosal sinus, and the superior ophthalmic vein itself when necessary.

Pathology

Common Injuries & Conditions

Arterialized Superior Ophthalmic Vein in CCF

A carotid-cavernous fistula produces anterograde arterialized flow through the superior ophthalmic vein visible on imaging as a markedly dilated superior ophthalmic vein draining to the medial orbit, producing pulsatile proptosis and conjunctival chemosis treatable by endovascular embolisation via the inferior petrosal sinus or the vein itself.