A vortex vein ampulla is a localized, harmless dilation of a vein at the back of the eye. Considered a normal anatomical variation rather than a disease, these structures are small enlargements where smaller veins merge into a larger one. An unusually large dilation of an ampulla is known as a varix, but this finding is not a threat to eye health.
The Eye’s Drainage System
The eye’s circulatory system includes the choroid, a dense layer of blood vessels between the retina and the sclera (the white of the eye). This vascular layer supplies oxygen and nutrients to the outer layers of the retina. The choroid’s health is maintained by a constant flow of blood, which is drained by a network of vessels called the vortex veins.
An eye has about four to eight vortex veins, with at least one located in each quadrant. These veins collect deoxygenated blood from the choroid and channel it out of the eyeball through small passages in the sclera. Before a vortex vein exits the globe, it is fed by smaller choroidal vessels that form a bulbous structure known as an ampulla, which can sometimes become enlarged.
The veins drain into the superior and inferior ophthalmic veins outside of the eyeball. This drainage pathway ensures that pressure within the choroidal space remains stable, which is important for the proper function of the overlying retina.
Identifying a Vortex Vein Ampulla
A vortex vein ampulla is most often discovered incidentally during a routine dilated eye examination. To an ophthalmologist viewing the fundus (the interior back surface of the eye), an ampulla appears as a round or oval-shaped lesion. Its color can range from reddish-brown to slate-gray and it is located in the mid-periphery of the fundus.
To confirm the finding, an eye care professional may use specialized imaging tools. Optical coherence tomography (OCT) provides a cross-sectional view of the retina and choroid, showing a smooth elevation of the choroid without fluid or retinal swelling. Fundus photography can document the lesion’s appearance, while indocyanine green angiography (ICGA) can visualize blood flow and confirm the structure’s vascular nature.
Clinical Significance and Symptoms
A vortex vein ampulla is a benign anatomical feature and is completely asymptomatic. It does not cause symptoms like vision loss, pain, flashes of light, or floaters, so people are unaware of its presence until it is noted by a clinician during an eye exam. Because it is a harmless variation, a vortex vein ampulla does not require treatment. Its discovery does not imply any underlying disease or future risk to a person’s vision. The standard approach is to monitor the finding through regular eye examinations to ensure the feature remains stable.
Distinguishing from Other Eye Conditions
Due to its appearance as a pigmented, elevated lesion, a vortex vein ampulla must be differentiated from more serious eye conditions. The most significant of these is a choroidal melanoma, a cancerous tumor that can develop in the choroid. It may also be confused with a choroidal nevus, a benign, mole-like growth in the eye.
An eye doctor uses several features to distinguish an ampulla from a tumor. A primary indicator is the ampulla’s dynamic nature; the size and prominence of the lesion change depending on the direction of gaze or if gentle pressure is applied to the globe. For instance, it may become more prominent when the patient looks toward it and flatten when gaze returns to a primary position. A melanoma is a solid tumor that does not change in this way. The location is also a clue, as ampullae are found where vortex veins exit the eye.
Imaging tests provide definitive evidence. An OCT scan of an ampulla shows a smooth elevation of choroidal vessels, while a melanoma appears as a solid mass. Indocyanine green angiography (ICGA) will show the ampulla filling with dye in a pattern consistent with a blood vessel, a characteristic not seen with tumors. An accurate diagnosis is important to avoid the anxiety and testing required if a melanoma were suspected.