Abstract
Purpose :
To evaluate the utility of computerized tomography (CT) scans in the diagnosis and management of open globe injuries in the emergency department (ED) at a tertiary care academic medical center.
Methods :
Retrospective analysis of all open globe injuries presenting to the ED at the Johns Hopkins Hospital between 2017-2018.
Results :
Between 2017-2018, a total of 155 patients with open globe injuries presented to the ED. Of these, 140/155 (90.3%) underwent computerized tomography (CT) imaging. An intraocular foreign body (IOFB) was identified in approximately 13% (18/140) of CT scans, with metal (14/18, 77.8%) the most commonly identified IOFB. Orbital fractures were present in 13.6% (19/140) of cases. In 98.6% of patients (138/140), the open globe injury was visible on slit-lamp examination. In one patient, the clinical examination was been obscured by total hyphema and the presence of an open globe was identified on CT imaging. In the second case, the presence of an open globe injury was not evident by clinical exam or CT imaging, but identified after exploration in the operating room.
Conclusions :
The majority of open globe injuries undergo CT, despite findings of an open globe being visible on clinical examination in 99% of cases. IOFBs are present in a small proportion of cases, with metal the most commonly identified offending agent. In light of the rising healthcare expenditures in the U.S., guidelines for CT imaging in the presence of a suspected open globe injury should be established, which may include obtaining CZT scans in the presence of an suspected IOFB, orbital fracture, or occult open globe injury.
This is a 2020 ARVO Annual Meeting abstract.