Injuries of the Globe: What Can the Radiologist Offer?

Abstract

Traumatic ocular injuries are a significant cause of blindness and visual deficits. In the setting of acute orbital trauma, urgent ophthalmologic evaluation and intervention are critical in preserving vision. However, in the acute trauma setting, clinical evaluation of the globe may be difficult in the presence of surrounding periorbital soft-tissue swelling and other associated injuries, and patient cooperation may be limited because of unresponsiveness, altered mentation, or sedation. Often, rapid access to imaging is part of the initial diagnostic evaluation, and radiologists may be the first to identify traumatic injuries of the globe. Because of this, radiologists should be familiar with normal orbital and globe anatomy at various imaging modalities and have a thorough understanding of the various patterns of ocular injury and their imaging appearances. Radiologists should also be familiar with the various mimics of ocular injury, including congenital and acquired conditions that may alter the shape of the globe, various types of ocular calcifications, and the different types of material used to treat retinal detachment. Such knowledge may help radiologists make accurate diagnoses, which facilitates prompt and appropriate patient care.

The hypoattenuating ocular lens on CT is not always due to cataract formation

“…Reports of hypoattenuating lenses found by the authors' then, and subsequently, were solely cases of nuclear cataract in humans. 2,9,22,25,26 Contrary to the pre-existing literature, our hypothesis was disproven in several ways. First, 100% of feline cases with a UB filter applied had a hypoattenuating halo surrounding the lens center.…”

“…Ultrasonography of the ocular lens has been described, and is readily accessible, but high operator dependence may limit utility in some cases, and it is contra‐indicated in cases of suspected globe rupture . Magnetic resonance imaging offers excellent soft tissue contrast resolution within the orbit; however, acquisition times are long, and it is the most expensive and least available of these options . CT utilizes ionizing radiation, but acquisition is rapid, and the modality is relatively available.…”

“…2,18 Magnetic resonance imaging offers excellent soft tissue contrast resolution within the orbit; however, acquisition times are long, and it is the most expensive and least available of these options. 2,19,20 CT utilizes ionizing radiation, but acquisition is rapid, and the modality is relatively available. Computed tomography also provides simultaneous assessment of other orbital and periorbital structures, and is the modality of choice for investigating traumatic globe injury in humans.…”

“…Computed tomography also provides simultaneous assessment of other orbital and periorbital structures, and is the modality of choice for investigating traumatic globe injury in humans. 1,2,8 Ocular biometry by CT has been described in the dog and cat. Though radiologic descriptions of the lens were not included in all of these studies, each image published was of a homogeneously attenuating lens, which was hyperattenuating to surrounding ocular tissue.…”

Demystifying Orbital Emergencies: A Pictorial Review

“…Furthermore, any alteration of the normal mean anterior chamber depth of 3.1 mm that is 0.8 mm or greater when compared with the contralateral eye is diagnostic for globe rupture (17). Depending on the segment that has lost volume, the anterior chamber depth may decrease or increase after injury to the anterior or posterior segment, respectively (5,16,18). In patients with multiple injuries and a likelihood of open globe injury, the clinician will focus on more life-threatening injuries and avoid any examination that might apply pressure to the globe.…”