Reza Bavarsad Shahripour: When the Ophthalmic Artery Tells the Story of the Carotid
Reza Bavarsad Shahripour, Associate Editor at Clinical Neuroimaging Journal, shared a post on LinkedIn:
“When the Ophthalmic Artery Tells the Story of the Carotid
In patients with internal carotid artery (ICA) occlusion, the ophthalmic artery often becomes a key window into cerebral hemodynamics.
In this case:
Right side:
- ICA occlusion
- Bidirectional / reversed flow in the right ophthalmic artery
Classic sign of collateral recruitment from the external carotid artery (ECA) supplying the intracranial circulation.
Left side:
- Antegrade ophthalmic artery flow with high resistance
Reflects hemodynamic asymmetry and altered distal demand in the setting of contralateral carotid occlusion.
Teaching Point
The ophthalmic artery is not just another orbital vessel – it is an important collateral gateway between the ECA and ICA systems.
When proximal ICA occlusion occurs, flow can reverse through branches such as:
- Facial artery
- Maxillary artery
- Superficial temporal artery
These channels feed the ophthalmic artery retrogradely, helping maintain cerebral perfusion.
Why this matters?
Recognizing these Doppler patterns can:
- Help identify proximal ICA occlusion even before angiography
- Demonstrate active collateralization
- Provide insight into cerebral hemodynamic compensation
For neurosonologists, these subtle orbital findings can reveal the entire cerebrovascular story upstream.
The eye truly becomes a window to the brain.”
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