Nervous system · Head and neck

V1 ophthalmic !

The ophthalmic nerve (V1), the top branch of the trigeminal nerve, gives feeling to the forehead, upper eyelid, eye surface and nose tip.

Official name: Ophthalmic nerve

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What it is

The top trigeminal branch, to the forehead, eye and nose.

What it does

Feeling of the forehead, upper lid, cornea and nose tip; shingles here threatens the eye.

Key facts

Roots

V1; superior orbital fissure (frontal, lacrimal, nasociliary branches)

Moves

None

Feeling from

Forehead, upper eyelid, cornea (corneal reflex), nose to the tip

Relations

Course

From the trigeminal ganglion forward in the lateral wall of the cavernous sinus; just before the superior orbital fissure it splits: the lacrimal and frontal nerves pass above the common tendinous ring, the nasociliary nerve through it; the frontal nerve ends on the forehead as the supraorbital and supratrochlear nerves

Above

In the cavernous sinus wall, the oculomotor nerve (III) and the trochlear nerve (IV)

Below

The V2 maxillary nerve, lowest in the lateral wall of the cavernous sinus

Medial

Within the cavernous sinus, the internal carotid artery and the abducens nerve (VI)

How to find it

Its skin territory runs from the upper eyelid and the bridge and tip of the nose up over the forehead to the vertex. The supraorbital notch is felt on the upper orbital margin at the junction of its inner third and outer two thirds.

Examination

• Corneal reflex: touching the edge of the cornea makes both eyes blink; no blink in either eye when one side is touched means an afferent (V1) lesion on that side, while one eye that never blinks means a facial nerve problem on that side
• Light touch and pinprick on the forehead, compared with the other side

On imaging

Seen mostly through its surroundings. Contrast MRI, coronal and axial, follows it in the lateral wall of the cavernous sinus to the superior orbital fissure; a mass or thrombosis in the sinus widens that wall or alters its enhancement. CT with bone windows shows the supraorbital notch and orbital roof fractures. In herpes zoster ophthalmicus, imaging is for complications.

Clinical notes

• Zoster ophthalmicus can cause keratitis, uveitis and corneal scarring, so the eye is examined even when only the skin seems affected
• Frontal and ethmoid sinusitis is felt over the forehead and between the eyes through V1 branches
• Superior orbital fissure syndrome: III, IV, V1 and VI affected together, with a frozen eye, ptosis and forehead numbness

Anatomical variants

• The supraorbital nerve leaves through a notch in many people and through a complete bony foramen in others; a foramen can sit a little above the orbital margin, which matters when placing a block

Memory aid

Its three branches: "NFL": Nasociliary, Frontal, Lacrimal.

Related conditions

• Cluster headache
• Herpes zoster ophthalmicus
• Migraine
• Trigeminal neuralgia

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2)

nervus ophthalmicus TA2 6196

Official Spanish (DeCS)

Nervio Oftálmico DeCS D009882

English (TA2)

Ophthalmic nerve

Also called

V1 · cranial nerve V1 · ophthalmic division of trigeminal nerve

Related

• Superior orbital fissure

Sources: Terminologia Anatomica (TA2); DeCS; Neuroanatomy, Cranial Nerve 5 (Trigeminal); Anatomy, Head and Neck: Eye Nerves; Anatomy of the Human Body (20th ed.): The Exterior of the Skull (Lea & Febiger (Gray's Anatomy, 1918), 1918) · adapted, Public domain.

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Representative model, for educational purposes only.