Malformation of those structures derived from the first and second branchial arches are frequently accompanied by ocular and adnexal abnormalities. Ophthalmologists should recognize the various syndromes involved so as to ensure appropriate multi-system evaluation of their patients, and the avoidance of potentially life threatening complications. The features of the major branchial arch syndromes are reviewed, and some of the concepts of pathogenesis considered. In particular, those teratogenic influences which might also explain some associated ophthalmic disorders, are discussed.