From the Guidelines
For suspected ruptured globe in ocular trauma, computed tomography (CT) scan without contrast is the preferred imaging modality. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of CT in evaluating orbital trauma and detecting fractures, soft tissue injuries, and intraocular foreign bodies 1. A thin-slice CT scan of the orbits and face should be ordered promptly to evaluate the integrity of the globe, identify any intraocular foreign bodies, and assess associated orbital or facial fractures.
Some key points to consider when ordering imaging for suspected globe rupture include:
- CT is superior to MRI in this emergency situation because it is faster, more readily available, and can detect metallic foreign bodies that would be contraindicated in MRI.
- Ultrasound should be avoided in suspected globe rupture as the pressure applied during the examination could extrude intraocular contents through the wound.
- X-rays have limited value as they cannot adequately visualize soft tissue injuries.
- While awaiting imaging, the eye should be protected with a rigid shield (not pressure patch), no eye drops should be instilled, and the patient should be instructed not to squeeze the eyelids.
The use of CT imaging in this context is supported by recent guidelines, which highlight its accuracy in detecting intraorbital foreign bodies and its usefulness in identifying fractures and displaced fracture trauma 1. However, the most recent study 1 takes precedence in guiding clinical decision-making. CT imaging helps guide surgical management decisions and timing, as globe rupture typically requires urgent surgical repair to preserve vision and prevent complications like endophthalmitis.
From the Research
Imaging Modalities for Suspected Globe Rupture
- Computed Tomography (CT) is considered the top choice for evaluating orbital trauma, including suspected globe rupture 2, 3
- CT can detect certain types of foreign bodies, lens dislocation, ruptured globe, choroidal or retinal detachments, or cavernous sinus thrombosis 2
- The diagnostic performance of CT in detecting globe rupture is more accurate in patients with orbital wall fractures, with a specificity of 97.2% and a negative predictive value of 97% 4
- However, isolated orbital CT alone does not have a sufficiently high diagnostic performance to be reliable to rule out all globe ruptures 4
Limitations of CT
- CT scan results may not have any influence on immediate treatment of open globe injury, but can influence decisions made after the initial operative stage 5
- CT evaluation may fail to correctly diagnose open globe injury in about one third of all unclear cases with rupture of the globe due to severe trauma 6
- Surgical sclera inspection is always mandatory in unclear trauma cases regardless of the CT results 6