WHAT TO LOOK FOR IN ACUTE ORBITAL TRAUMA
David Alves Berhanu
Introduction: Orbital traumatic injury can be the cause of severe visual deficits and blindness. Urgent assessment and evaluation is often required in the setting of orbital trauma. Correct complete clinical assessment is many times not possible, because of uncooperative, impaired mental status or sedated patients, or associated traumatic lesions and periorbital edema. Therefore, imaging plays a key role in the diagnostic evaluation.
Common post-traumatic injuries to the orbit include injuries to the anterior and posterior segments, which includes anterior chamber injuries and ocular detachments; injuries to the lens; open-globe/ruptured globe injuries and intraorbital foreign bodies. Computed tomography is the imaging technique of choice, because of fast acquisition time and no contraindications in the potential case of a metallic intraorbital foreign body or ruptured globe.
Methods: We looked at exemplifying traumatic orbital trauma cases at a tertiary care center and evaluated the imaging findings associated with the most common traumatic ocular injuries. We aimed to identify the characteristics of traumatic injuries and their associated presentation in real cases in order to stratify the approach the neuroradiologist should undertake when faced with these cases.
Final Considerations: The evaluation of traumatic orbital injuries should include several important steps to assess the most common lesions. The radiologist should (1) evaluate the anterior chamber and presence of collection in its interior; (2) look at the lens position and consider the possibility of a partial lens dislocation, which is a subtle imaging finding; (3) finally, it is important to evaluate the posterior segment for collections or ocular detachments and presence of intraorbital foreign bodies.
Additionally, it is important to evaluate the optic nerve, vascular structures (ophthalmic veins) and injury to the orbit or maxillo-facial bone structures.
These steps are important to recognise the most important orbital lesions in the acute trauma setting.