Trauma/Emergency Radiology

Injuries of the Globe: What Can the Radiologist Offer?

Published Online:May 1 2014https://doi.org/10.1148/rg.343135120

Abstract

Knowledge of normal ocular anatomy, the various patterns of ocular injury and their imaging appearances, and potential mimics of injury are crucial for radiologists to accurately diagnose globe injuries, which may facilitate prompt and appropriate patient care.

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.

©RSNA, 2014

References

1. Dunkin JM , Crum AV , Swanger RS , Bokhari SA . Globe trauma . Semin Ultrasound CT MR 2011 ; 32 ( 1 ): 51 – 56 . Crossref, Medline, Google Scholar
2. Kubal WS . Imaging of orbital trauma . RadioGraphics 2008 ; 28 ( 6 ): 1729 – 1739 . Link, Google Scholar
3. Koo L , Kapadia MK , Singh RP , Sheridan R , Hatton MP . Gender differences in etiology and outcome of open globe injuries . J Trauma 2005 ; 59 ( 1 ): 175 – 178 . Crossref, Medline, Google Scholar
4. Amrith S , Saw SM , Lim TC , Lee TK . Ophthalmic involvement in cranio-facial trauma . J Craniomaxillofac Surg 2000 ; 28 ( 3 ): 140 – 147 . Crossref, Medline, Google Scholar
5. Greven CM , Engelbrecht NE , Slusher MM , Nagy SS . Intraocular foreign bodies: management, prognostic factors, and visual outcomes . Ophthalmology 2000 ; 107 ( 3 ): 608 – 612 . Crossref, Medline, Google Scholar
6. Smith D , Wrenn K , Stack LB . The epidemiology and diagnosis of penetrating eye injuries . Acad Emerg Med 2002 ; 9 ( 3 ): 209 – 213 . Crossref, Medline, Google Scholar
7. Guly CM , Guly HR , Bouamra O , Gray RH , Lecky FE . Ocular injuries in patients with major trauma . Emerg Med J 2006 ; 23 ( 12 ): 915 – 917 . Crossref, Medline, Google Scholar
8. Scruggs D , Scruggs R , Stukenborg G , Netland PA , Calland JF . Ocular injuries in trauma patients: an analysis of 28,340 trauma admissions in the 2003-2007 National Trauma Data Bank National Sample Program . J Trauma Acute Care Surg 2012 ; 73 ( 5 ): 1308 – 1312 . Crossref, Medline, Google Scholar
9. Brown MS , Ky W , Lisman RD . Concomitant ocular injuries with orbital fractures . J Craniomaxillofac Trauma 1999 ; 5 ( 3 ): 41 – 46 ; discussion 47–48 . Medline, Google Scholar
10. Cook T . Ocular and periocular injuries from orbital fractures . J Am Coll Surg 2002 ; 195 ( 6 ): 831 – 834 . Crossref, Medline, Google Scholar
11. Jamal BT , Pfahler SM , Lane KA , et al . Ophthalmic injuries in patients with zygomaticomaxillary complex fractures requiring surgical repair . J Oral Maxillofac Surg 2009 ; 67 ( 5 ): 986 – 989 . Crossref, Medline, Google Scholar
12. Magarakis M , Mundinger GS , Kelamis JA , Dorafshar AH , Bojovic B , Rodriguez ED . Ocular injury, visual impairment, and blindness associated with facial fractures: a systematic literature review . Plast Reconstr Surg 2012 ; 129 ( 1 ): 227 – 233 . Crossref, Medline, Google Scholar
13. Kulkarni AR , Aggarwal SP , Kulkarni RR , Deshpande MD , Walimbe PB , Labhsetwar AS . Ocular manifestations of head injury: a clinical study . Eye (Lond) 2005 ; 19 ( 12 ): 1257 – 1263 . Crossref, Medline, Google Scholar
14. Malhotra A , Minja FJ , Crum A , Burrowes D . Ocular anatomy and cross-sectional imaging of the eye . Semin Ultrasound CT MR 2011 ; 32 ( 1 ): 2 – 13 . Crossref, Medline, Google Scholar
15. Caranci F , Cicala D , Cappabianca S , Briganti F , Brunese L , Fonio P . Orbital fractures: role of imaging . Semin Ultrasound CT MR 2012 ; 33 ( 5 ): 385 – 391 . Crossref, Medline, Google Scholar
16. Lee HJ , Jilani M , Frohman L , Baker S . CT of orbital trauma . Emerg Radiol 2004 ; 10 ( 4 ): 168 – 172 . Crossref, Medline, Google Scholar
17. Fulcher TP , McNab AA , Sullivan TJ . Clinical features and management of intraorbital foreign bodies . Ophthalmology 2002 ; 109 ( 3 ): 494 – 500 . Crossref, Medline, Google Scholar
18. Gor DM , Kirsch CF , Leen J , Turbin R , Von Hagen S . Radiologic differentiation of intraocular glass: evaluation of imaging techniques, glass types, size, and effect of intraocular hemorrhage . AJR Am J Roentgenol 2001 ; 177 ( 5 ): 1199 – 1203 . Crossref, Medline, Google Scholar
19. Patel SN , Langer PD , Zarbin MA , Bhagat N . Diagnostic value of clinical examination and radiographic imaging in identification of intraocular foreign bodies in open globe injury . Eur J Ophthalmol 2012 ; 22 ( 2 ): 259 – 268 . Crossref, Medline, Google Scholar
20. Pinto A , Brunese L , Daniele S , et al . Role of computed tomography in the assessment of intraorbital foreign bodies . Semin Ultrasound CT MR 2012 ; 33 ( 5 ): 392 – 395 . Crossref, Medline, Google Scholar
21. Smith AB , Dillon WP , Gould R , Wintermark M . Radiation dose-reduction strategies for neuroradiology CT protocols . AJNR Am J Neuroradiol 2007 ; 28 ( 9 ): 1628 – 1632 . Crossref, Medline, Google Scholar
22. Fielding JA . The assessment of ocular injury by ultrasound . Clin Radiol 2004 ; 59 ( 4 ): 301 – 312 . Crossref, Medline, Google Scholar
23. Schott ML , Pierog JE , Williams SR . Pitfalls in the use of ocular ultrasound for evaluation of acute vision loss . J Emerg Med 2013 ; 44 ( 6 ): 1136 – 1139 . Crossref, Medline, Google Scholar
24. Adesanya OO , Dawkins DM . Intraorbital wooden foreign body (IOFB): mimicking air on CT . Emerg Radiol 2007 ; 14 ( 1 ): 45 – 49 . Crossref, Medline, Google Scholar
25. John SS , Rehman TA , John D , Raju RS . Missed diagnosis of a wooden intra-orbital foreign body . Indian J Ophthalmol 2008 ; 56 ( 4 ): 322 – 324 . Crossref, Medline, Google Scholar
26. Rao SK , Nunez D , Gahbauer H . MRI evaluation of an open globe injury . Emerg Radiol 2003 ; 10 ( 3 ): 144 – 146 . Crossref, Medline, Google Scholar
27. Saeed A , Cassidy L , Malone DE , Beatty S . Plain x-ray and computed tomography of the orbit in cases and suspected cases of intraocular foreign body . Eye (Lond) 2008 ; 22 ( 11 ): 1373 – 1377 . Crossref, Medline, Google Scholar
28. Kim SY , Lee JH , Lee YJ , et al . Diagnostic value of the anterior chamber depth of a globe on CT for detecting open-globe injury . Eur Radiol 2010 ; 20 ( 5 ): 1079 – 1084 . Crossref, Medline, Google Scholar
29. Bron AJ , Vrensen GF , Koretz J , Maraini G , Harding JJ . The ageing lens . Ophthalmologica 2000 ; 214 ( 1 ): 86 – 104 . Crossref, Medline, Google Scholar
30. Boncoeur-Martel MP , Adenis JP , Rulfi JY , Robert PY , Dupuy JP , Maubon A . CT appearances of chronically retained wooden intraorbital foreign bodies . Neuroradiology 2001 ; 43 ( 2 ): 165 – 168 . Crossref, Medline, Google Scholar
31. Nasr AM , Haik BG , Fleming JC , Al-Hussain HM , Karcioglu ZA . Penetrating orbital injury with organic foreign bodies . Ophthalmology 1999 ; 106 ( 3 ): 523 – 532 . Crossref, Medline, Google Scholar
32. LeBedis CA , Sakai O . Nontraumatic orbital conditions: diagnosis with CT and MR imaging in the emergent setting . RadioGraphics 2008 ; 28 ( 6 ): 1741 – 1753 . Link, Google Scholar
33. Erdurman FC , Hurmeric V , Gokce G , Durukan AH , Sobaci G , Altinsoy HI . Ocular injuries from improvised explosive devices . Eye (Lond) 2011 ; 25 ( 11 ): 1491 – 1498 . Crossref, Medline, Google Scholar
34. Morley MG , Nguyen JK , Heier JS , Shingleton BJ , Pasternak JF , Bower KS . Blast eye injuries: a review for first responders . Disaster Med Public Health Prep 2010 ; 4 ( 2 ): 154 – 160 . Crossref, Medline, Google Scholar
35. Wolf SJ , Bebarta VS , Bonnett CJ , Pons PT , Cantrill SV . Blast injuries . Lancet 2009 ; 374 ( 9687 ): 405 – 415 . Crossref, Medline, Google Scholar

Article History

Received: June 3 2013
Revision requested: July 11 2013
Revision received: Aug 19 2013
Accepted: Aug 29 2013
Published online: May 2014
Published in print: May 2014

Vol. 34, No. 3

Metrics

Altmetric Score

PDF download