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Anastasia Traband, Roya Ghafouri; Injuries to the Globe: A Combined Radiographic and Clinical Approach. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2309.
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Urgent ophthalmologic evaluation is important for prompt and appropriate management of ocular injuries. Trauma to the eye and surrounding tissues are evaluated with a thorough history and physical, and appropriate radiographic studies. In the acute setting of trauma, physical examination of the globe can be difficult due to surrounding periorbital soft tissue swelling, other associated injuries, and limited patient cooperation. In these patients radiographic studies can aid in the diagnosis of injuries to the globe. The purpose of this study is to evaluate various radiographic modalities that can be performed in patients presenting with orbital trauma, and identify patterns for recognition and early diagnosis when physical examination is challenging.
The study is a retrospective review of 55 patients who presented to Boston Medical Center between 2000 and 2012 with ocular and orbital trauma. Patients presented with a wide variety of ocular injuries and were evaluated by various radiographic modalities including x-ray, ultrasound, CT, and MRI. Anterior and posterior segment photos were also obtained in many cases and used for clinical correlation.
All of the imaging obtained was reviewed in the acute setting. Both obvious and subtle radiologic findings were discovered that assisted in identifying traumatic ocular injuries. The diagnoses were later confirmed by clinical examination in the appropriate setting. Very frequently these findings guided the clinician in management decisions and plans for surgical intervention when physical examination was limited.
Radiographic studies are invaluable in the assessment of ocular and orbital trauma in the acute setting. These studies can evaluate the bony orbit, lens position, globe integrity, optic nerve complex, posterior segment, and presence of intraocular foreign bodies. Although thin section axial CT is the imaging modality of choice in most cases of ocular trauma, in situations where it is unavailable, ultrasound, x-ray, and MRI can additionally provide diagnostic value. Identifying the various radiographic patterns of ocular and orbital trauma are crucial for accurate diagnosis and timely management in patients presenting with vision threatening injuries.
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