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Chapter 2: Surgical Anatomy :
Vortex veins
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There are normally four vortex veins in each eye. They are located roughly equidistant in the quadrants of the globe; that is, 90 degrees apart (Figure 57). These veins drain blood from the iris, ciliary body, and choroid. Their appearance is variable and rarely will they number greater than four. These veins have a tortuous 5-7 mm intrascleral course and a similar extrascleral course before passing through posterior Tenon’s into the intraconal space. The superior vortex veins empty into the superior orbital vein, and the remaining vortex veins empty into the inferior orbital vein.
A |
B | Figure 57 The four vortex veins are viewed from the posterior aspect of the globe.
A Lateral B Medial
In the course of strabismus surgery, each of the vortex veins seems to have its own ‘personality’ (Figure 58). The superior temporal vortex vein is seen at the posterior insertion of the superior oblique tendon. This is a reliable finding. The superior nasal vortex vein and/or the inferior nasal vortex vein may be seen while recessing the medial rectus, but rarely.
Figure 58
A The superior temporal vortex vein is seen at the posterior insertion of the superior oblique. Vortex veins are not seen routinely during surgery on the superior rectus.
B A vortex vein may be seen but rarely at either (or both) borders of the medial rectus.
C A vortex vein is seen routinely under the mid-belly of the distal inferior oblique.
D Vortex veins are seen at one or both borders of the inferior rectus.
The inferior nasal and inferior temporal vortex veins are observed in almost every case of inferior rectus surgery. This occurs because the inferior vortex veins are situated about 1 mm closer to the midline near the equator. Dissection of the inferior rectus is usually carried posteriorly to a point often posterior to the inferior vortex veins to limit the lid effects of Lockwood’s ligament. The inferior temporal vortex vein is encountered in nearly every case when engaging the inferior oblique in the inferior temporal quadrant. It is rare to encounter a vortex vein during surgery on the superior or lateral rectus.
If the surgeon exercises reasonable care, the vortex veins will remain intact. They look vulnerable but are actually fairly resistant to careful manipulation. Rupture of a vortex vein is rare, if surgery is done carefully. If a vortex vein is ruptured, it is treated with compression, and if necessary, cautery. A great deal of discoloration and swelling will occur, but there is no lasting complications to the surgery.
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