CT of orbital trauma

Abstract

In a patient with acute orbital trauma, visual acuity and extraocular muscle motility are the two most important ophthalmologic functions to be evaluated emergently. The assessment of these capabilities may sometimes be difficult due to the severity of the head injury, the extent of periorbital soft tissue edema, inadequate cooperation in alert patients, and a reduced level of consciousness in obtunded individuals. Consequently, computed tomography (CT) has come to play a major role in the orbital examination of acute trauma patients. In this study, in conjunction with clinical evaluation, we have sought to utilize CT to determine the various prevalences of the causes of decreased visual acuity and extraocular muscle motility resulting from orbital trauma. We retrospectively reviewed the records of all patients admitted to our emergency facility who, having suffered head trauma, underwent a CT study for diagnosis. CT examinations of the head using a multidetector scanner were performed from the base of the skull to the vertex at 5-mm intervals. Orbital CT was obtained when a routine CT of the head showed periorbital soft tissue edema and/or facial bone fractures. The orbital CT examination was performed using axial 1-mm and coronal 3-mm slices. Coronal reformation images were prepared if the patient was unable to tolerate the prone position for direct coronal imaging. The imaging findings were correlated with ophthalmologic observations. The orbit floor was the most common and the orbital roof the least common site of fracture of the bony coverings of the eye. Twenty-three patients suffered decreased visual acuity. In order of declining frequency, the causes of reduced vision consequent to trauma were retrobulbar hemorrhage, optic nerve thickening presumably secondary to edema, intraorbital emphysema, optic nerve impingement, detached retina and ruptured globe. Five patients had visual impairment without demonstratable radiographic abnormalities. The most common finding associated with diminished extraocular muscle motility was muscle impingement by fracture fragments, followed in decreasing frequency by thickened muscle due to edema or contusion, intraconal emphysema, muscle entrapment, and retrobulbar fat herniation. Six patients with decreased extraocular muscle activity had no abnormalities demonstrated on CT images. The overwhelming majority of patients with decreased visual acuity or reduced extraocular muscle motility consequent to trauma had abnormalities demonstrated by orbital CT. Hence, CT examinations should play a major role in the evaluation of the intraorbital contents in patients with orbital trauma.

Retrospective Analysis Of 132 Patients With Orbital Fracture

“…When they are suspected, the diagnosis is made by orbital computerized tomography (CT) examination. [7] The difference between our rates of medial wall fractures and those in the literature may be due to the systematic use of CT in all of our cases.…”

Morphological characteristics and clinical manifestations of orbital emphysema caused by isolated medial orbital wall fractures

“…These patients fully recovered with no supraduction limitation, no eyelid swelling, no crepitus at palpation, and no diplopia within 7 days in all cases. Air in the orbit can be detected by radiographic examination, most precisely by CT. 4 Radiographic Figure 2 A case with supraduction limitation induced by orbital emphysema. A 14-year-old boy was hit in both eyes and blew his nose due to a nose-bleed immediately after the trauma.…”

“…Orbital emphysema is often regarded as a self-limiting condition requiring no treatment and is not typically associated with any complications. [1][2][3][4][5][6][7] Although some orbital emphysema cases with severe complications were reported, there has been no study that analyzed large case series of orbital emphysema. [8][9][10][11] The present study investigated the morphological characteristics and clinical manifestations of orbital emphysema in patients with isolated medial orbital wall fractures.…”

Post-Traumatic Fronto-Ethmoidal and Orbital Encephalocele – A Rare Entity

“…But with the advent of multislice CT with isotropic resolution and high-resolution MRI, the bony defects with herniation of intracranial contents and advancing CSF-fluid pouch can be adequately demonstrated as seen in our index case [7].…”