Ophtho On Call Case 6: Case Continued…

Ophtho On Call Case 6 Index

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:

R globe rupture radiopaedia

Above image credit: Mostafa M. Traumatic rupture of the globe. Case study, Radiopaedia.org

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. 


What are the best next steps? Click all that apply
Keep patient NPO and prepare for urgent globe exploration and repair
Administer IV antibiotics
Discharge home on topical antibiotics
Perform lateral canthotomy/catholysis

Click here to move on!

Ophtho On Call Case 6 Index
Ophtho On Call Case 6: Introduction
Ophtho On Call Case 6: Additional History
Ophtho On Call Case 6: Physical Exam