Ocular Imaging

  • Paul Basel


Several imaging modalities exist for ocular diseases and traumatic injuries. CT orbit is the preferred imaging modality in trauma. CT is insensitive for diagnosing open globe. If the history or physical examination suggests open globe but imaging is negative, the patient may still need surgical exploration due to the poor sensitivity of the test. In cases of suspected IOFB, CT scanning of orbits is the preferred and most sensitive modality. MRI should not be performed unless metallic IOFB has been ruled out. If suspicion for IOFB remains high despite negative CT scanning, MRI or US may be reasonable to evaluate for less common objects such as wood. The majority of medical conditions do not require advanced imaging. When advanced imaging is required, MRI with contrast provides the greatest soft tissue detail; however, CT orbits with contrast are often an acceptable choice. When evaluating for post-septal cellulitis, MRI orbits with contrast and CT orbits with contrast are both adequate imaging choices. Consider MRI in the pediatric population to limit radiation exposure. Physical exam can rule out post-septal cellulitis in many cases; when the diagnosis is unclear, imaging is indicated. The diagnosis of optic neuritis can be made clinically. Atypical presentations may warrant imaging for other possible causes. MRI brain and orbits with contrast can confirm the diagnosis or demonstrate alternative diagnosis.


MRI orbits CT orbits Ocular trauma Orbital cellulitis Preseptal cellulitis Optic neuritis Intraocular foreign body Orbital wall fracture 


  1. 1.
    Kubal WS. Imaging of orbital trauma. Radiographics. 2008;28(6):1729–39. Scholar
  2. 2.
    Sung EK, Nadgir RN, Fujita A, et al. Injuries of the globe: what can the radiologist offer? Radiographics. 2014;34(3):764–76. Scholar
  3. 3.
    Yuan WH, Hsu HC, Cheng HC, et al. CT of globe rupture: analysis and frequency of findings. Am J Roentgenol. 2014;202(5):1100–7. Scholar
  4. 4.
    Joseph DP, Pieramici DJ, Beauchamp NJ. Computed tomography in the diagnosis and prognosis of open-globe injuries. Ophthalmology. 2000;107:1899–906.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Arey ML, Mootha VV, Whittemore AR, Chason DP, Blomquist PH. Computed tomography in the diagnosis of occult open-globe injuries. Ophthalmology. 2007;114(8):1448–52. Scholar
  6. 6.
    Bray LC, Griffiths PG. The value of plain radiography in suspected intraocular foreign body. Eye. 1991;5:751–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Saeed a CL, 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):1373–7. Scholar
  8. 8.
    Gor DM, Kirsch CF, Leen J, Turbin R, Von Hagen S, et al. Am J Roentgenol. 2001;177(5):1199–203. doi: 0361–803X/01/1775–1199.CrossRefGoogle Scholar
  9. 9.
    Nagae LM, Katowitz WR, Bilaniuk LT, Anninger WV, Pollock AN. Radiological detection of intraorbital wooden foreign bodies. Pediatr Emerg Care. 2011;27(9):895–6. Scholar
  10. 10.
    Brady SM, McMann MA, Mazzoli RA, Bushley DM, Ainbinder DJ, Carroll RB. The diagnosis and management of orbital blowout fractures: update 2001. Am J Emerg Med. 2001;19(2):147–54. Scholar
  11. 11.
    Wippold II FJ, Cornelius RS, Berger KL, Broderick DF, Davis PC, Douglas AC, Germano IM, Hadley JA, McDermott MW, Mechtler LL, Smirniotopoulos JG, Waxman AD. ACR appropriateness criteria® orbits, vision and visual loss. 2012.Google Scholar
  12. 12.
    Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM. Tintinalli’s emergency medicine a comprehensive study guide. New York: McGraw-Hill Education; 2016. p. 2128.Google Scholar
  13. 13.
    Howe L, Jones NS. Guidelines for the management of periorbital cellulitis/abscess. Clin Otolaryngol Allied Sci. 2004;29(6):725–8. Scholar
  14. 14.
    C a LB, Sakai O. Nontraumatic orbital conditions: diagnosis with CT and MR imaging in the emergent setting. Radiographics. 2008;28(6):1741–53. Scholar
  15. 15.
    Lee S, Yen MT. Management of preseptal and orbital cellulitis. Saudi J Ophthalmol. 2011;25(1):21–9. Scholar
  16. 16.
    Rudloe TF, Harper MB, Prabhu SP, Rahbar R, VanderVeen D, Kimia AA. Acute periorbital infections: who needs emergent imaging? Pediatrics. 2010;125(4):e719–26. Scholar
  17. 17.
    Starkey CR, Steele RW. Medical management of orbital cellulitis. Pediatr Infect Dis J. 2001;20(10):1002–5. Scholar
  18. 18.
    Osborne BJ, Volpe NJ. Optic neuritis and risk of MS: differential diagnosis and management. Cleve Clin J Med. 2009;76(3):181–90. Scholar
  19. 19.
    Lee AG, Lin DJ, Kaufman M, Golnik KC, Vaphiades MS, Eggenberger E. Atypical features prompting neuroimaging in acute optic neuropathy in adults. Can J Ophthalmol. 2000;35(6):325–30. Accessed 17 Sept 2016.CrossRefPubMedGoogle Scholar
  20. 20.
    Kupersmith MJ, Alban T, Zeiffer B, Lefton D. Contrast-enhanced MRI in acute optic neuritis: relationship to visual performance. Brain. 2002;125(Pt 4):812–22. Scholar
  21. 21.
    Rocca MA, Hickman SJ, Bö L, et al. Imaging the optic nerve in multiple sclerosis. Mult Scler. 2005;11(5):537–41. Scholar
  22. 22.
    Wilhelm H, Schabet M. Diagnostik und Therapie der Optikusneuritis. Dtsch Arztebl. 2015;112:616–26. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Paul Basel
    • 1
  1. 1.Department of Emergency MedicineSan Antonio Uniformed Services Health Education ConsortiumSan AntonioUSA

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