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Purpose: The ophthalmic artery (OA) has one of the most complex anatomy and the most fascinating embryological development. Methods: The complexity of the embryologic development of the OA resides in the implication of three different embryological systems: the carotid system, the stapedial system, and the ventral pharyngeal system. Results: This explains very well the numerous variations in origin of the OA and the importance of vascular anastomoses developed with branches of the external carotid artery and with the middle meningeal artery. Conclusion: In this review, authors propose a comprehensive description of different hypotheses on the embryologic development of the OA and, in a second part, explain all anatomical variations and clinical implications of this artery. [ABSTRACT FROM AUTHOR]