Central retinal artery: anatomy and relation to the face

The central retinal artery is the artery that carries blood to the inner layers of the retina. It is one of the first branches of the ophthalmic artery, enters the optic nerve shortly behind the eyeball and runs inside it to the back of the eye. In facial harmonization it matters because its occlusion by injected product is the most cited mechanism of vision loss after facial filler.

What is the course of the central retinal artery?

The ophthalmic artery leaves the internal carotid and enters the orbit through the optic canal. Right at the start, it gives off the central retinal artery, which runs a short stretch alongside the optic nerve and then penetrates it, about 1 cm behind the globe. Inside the nerve, it continues to the optic disc, where it divides:

It is an end artery: there is practically no alternative circulation for the inner layers of the retina. In some people there is a cilioretinal artery, coming from the choroidal circulation, which supplies a small central area and can preserve part of the vision in an occlusion.

How is the face connected to this circulation?

The ophthalmic artery has branches that leave the orbit and supply the face: supratrochlear, supraorbital, dorsal nasal and palpebral branches. These branches communicate (anastomose) with branches of the facial artery, such as the angular artery, and with branches of the superficial temporal artery.

The mechanism described is retrograde embolism: if the filler enters one of these arteries and the injection pressure exceeds the blood pressure, the product can travel against the flow to the ophthalmic artery. When the pressure stops, normal flow carries it forward, to the central retinal artery or to the posterior ciliary arteries.

That is why the regions most cited as risky for vision loss are the glabella, the nose, the area around the eyes, including the tear trough, the forehead and the nasolabial fold.

What do the consensus guidelines say about management?

This page is not a protocol. Published consensus documents on vascular complications treat vision loss as an emergency requiring immediate referral to an ophthalmologist and an emergency service. Measures in the office, including the use of hyaluronidase in cases of hyaluronic acid and the route of administration, remain under discussion in the literature, without uniformly proven efficacy. Prevention remains the most important resource.

For the general picture of complications, see safety and complications.

How does it show up in the assessment?

The artery is not assessed in the aesthetic exam, but the risk is. During the assessment, it is worth recording previous procedures around the eyes, nose and glabella, earlier surgeries that change the anatomy and any pre-existing visual complaint, to have a reference if a symptom appears later.

Also called: arteria centralis retinae, retinal artery.