Patterns of blood flow in episcleral vessels studied by low-dose fluorescein videoangiography

The blood supply of the ocular anterior segment arises from a saggittal arterial ring composed of the long posterior ciliary arteries, the muscular and anterior ciliary arteries and perforating scleral arteries. This ring supplies coronal arterial circles within and outside the globe. Low dose anterior segment fluorescein videoangiography demonstrates arterial and venous flow, recording its characteristics and direction. Videoangiograms were performed at low and high magnification in 15 normal subjects. Episcleral arteries and veins were distinguishable by the presence or absence of pulsatile flow and by their fluorescence intensity. Arteries usually perfused earlier than veins, and with higher flow velocity. Twenty-five of 40 arteries flowed away from scleral perforations close to the limbus. All 8 veins drained away from the limbus. The communication between two arteries may be demonstrated by a static, pulsating column of non-fluoresceinated blood. This sign arose at a point of scleral perforation, at the junction between muscular and anterior ciliary arteries and in the episcleral anterior circle. It supports the concept of arterial shunting, both in the saggittal plane and in the superficial coronal circle. Perforating scleral arteries lay anterior to the episcleral arterial circle in superior angiograms and posterior to it in inferior studies. Vessels that had been characterised by videoangiography were identified in stereo colour photographs of angiographic fields. Arteries were best distinguished from veins by their high tortuosity and thick walls. Using these photographic characteristics, the distribution of arteries and veins over the rectus muscles was surveyed in 13 subjects. The incidence of arteries is lowest over the lateral rectus muscle. Veins were concentrated in the vertical meridian and were absent over lateral rectus in 8 subjects. Five intra-operative videoangiograms are reported. Retraction of conjunctiva facilitated imaging of the episcleral vessels and demonstrated arterial communication through a shared capillary bed.