Answer: Noncontrast orbital CT is a useful adjunct test for suspected globe rupture to rule out intraocular foreign body. It can also be used to assess the globe contour and any additional abnormalities (i.e. orbital fracture, retrobulbar hematoma, etc). MRI would be contraindicated, especially if there is a concern for a metallic intraocular foreign body. X-ray could detect a metallic foreign body but it would not be able to identify radiolucent material or soft tissue.
B-scans can also be a helpful imaging technique to examine the posterior segment. However, this is a relative contraindication as it may exert external pressure and risk further prolapse of intraocular contents.
An example of noncontrast CT orbit demonstrating right globe rupture shown below:
The CT reveals distortion of the globe with loss of normal contour and volume. Another cut, not shown, confirms the right optic nerve appears intact. In this example, a hyperdense foreign body is seen in the intraorbital space. Howerver, no intraocular foreign body is present.
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