Radiologic Findings in Infected and Noninfected Scleral Buckles

Abstract

CT or MR can assist in the early diagnosis and management of scleral buckle infections.

Clinical-Radiological Correlation of Retained Silicone Sponge Presenting as Orbital Inflammation

“…Scleral buckle-associated infection or inflammation may present with a range of signs and symptoms, from pain, redness, foreign body sensation, and discharge to fulminant orbital cellulitis with vision loss, proptosis, chemosis, and ophthalmoplegia [ 1 – 3 , 5 , 6 , 9 , 10 ]. Considering the overall mild set of signs and symptoms, the clinical presentation of this patient may be due to inflammatory rather than infectious causes, but distinguishing infectious versus noninfectious inflammation may be difficult.…”

“…Considering the overall mild set of signs and symptoms, the clinical presentation of this patient may be due to inflammatory rather than infectious causes, but distinguishing infectious versus noninfectious inflammation may be difficult. On CT imaging, infected buckles are often associated with preseptal edema, diffuse scleral thickening, or extraocular muscle thickening, which this patient's imaging lacked [ 1 ]. The adjacent soft tissue attenuation observed on this patient's CT is likely related to the inflammation affecting nearby tissues.…”

“…The density of the sponge is similar to air because of the air pockets within the material, with an attenuation of −250 to −400 Hounsfield units [ 8 ]. The borders of the sponges are typically smooth on CT [ 1 , 2 , 8 , 12 ]. Infected sponges are more highly attenuated [ 1 ].…”

“…Scleral buckle infections range in clinical appearance from pain, conjunctivitis, and redness to orbital cellulitis or even scleral abscesses with vitritis [ 1 – 4 ]. Treatment of such infections includes systemic and topical antibiotics at first but often requires explanation of the buckle [ 1 – 3 , 5 ]. Scleral buckle elements may also cause sterile inflammation or orbital pseudocellulitis [ 3 , 6 , 7 ].…”

“…The radiologic features of scleral buckles and infected scleral buckles with or without orbital cellulitis have been described [ 1 – 3 , 8 ]. The prior cases and case series that cite specific clinical signs and symptoms with radiographic correlations describe orbital cellulitis in primary scleral buckles, but not in eyes with retained buckles after prior explantation.…”