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.
KeywordsMRI orbits CT orbits Ocular trauma Orbital cellulitis Preseptal cellulitis Optic neuritis Intraocular foreign body Orbital wall fracture
- 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.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