Imaging of adult ocular and orbital pathology--a pictorial review

Abstract

Orbital pathology often presents a diagnostic challenge to the reporting radiologist. The aetiology is protean, and clinical input is therefore often necessary to narrow the differential diagnosis. With this manuscript, we provide a pictorial review of adult ocular and orbital pathology.

Keywords: Orbit; adult; bone lesions; endocrine; globe; iatrogenic; infectious; inflammatory; neoplastic; paranasal sinuses; pathology; trauma; vascular.

Figure 1

Capillary hemangioma in an asymptomatic 50 year old female. A well circumscribed intra-conal lesion is seen which displays marked homogenous T2 hyperintensity (arrows - images A and D). The lesion is isointense to grey matter on T1 (images B and E), and demonstrates typical avid enhancement on the fat suppressed post contrast sequences (images C and F). (Protocol: Siemens Symphony 1.5T MRI. Image A: Coronal T2, TR/TE - 4690/109ms, 4mm slice thickness, 512 × 250 matrix, non-contrast. Image B: Coronal T1, TR/TE - 473/12ms, 4mm slice thickness, 256 × 192 matrix, non-contrast. Image C: Coronal T1, TR/TE - 426/12ms, 4mm slice thickness, 256 × 192 matrix, Gadavist: 0.1 mmol/kg. Image D: Axial T2, TR/TE - 4950/95ms, 4mm slice thickness, 512 × 218 matrix, non-contrast. Image E: Axial T1, TR/TE - 523/14ms, 3mm slice thickness, 512 × 250 matrix, non-contrast. Image F: Coronal T1, TR/TE - 644/12ms, 3mm slice thickness, 256 × 192 matrix, Gadavist: 0.1 mmol/kg.)

Figure 2

Orbital varix in a 84 year old female. Contiguous contrast enhanced CT images demonstrate an engorged tubular channel (arrowheads) which characteristically tapers towards the orbital apex. No internal septations are seen. The diagnosis of orbital varix was confirmed on Doppler ultrasound which showed low-velocity flow with increase in size following Valsalva maneuver. (Protocol: GE BrightSpeed Elite 16 Slice CT at 140mA and 120kV, 5mm slice thickness, non contrast).

Figure 3

Martin-Spezler grade 5 left frontal arteriovenous malformation (AVM) in a 64 year old male. The AVM is seen as a cluster of signal voids on axial FLAIR (image A), axial and sagittal T2 (images B and C respectively) weighted sequences. The increased venous pressure causes engorgement of the superior orbital veins (arrows) likely responsible for the patient’s main complaint of retro-orbital pressure sensation. Venous drainage to both deep (black arrowhead) and superficial cortical veins (white arrowhead) is noted. (Protocol: GE Signa EXCITE 1.5T MRI. Image A: Axial FLAIR, TR/TE - 8502/163ms, 4mm slice thickness, 320 × 224 matrix, non-contrast. Image B: Axial T2, TR/TE - 6000/33ms, 6mm slice thickness, 512 × 256 matrix, non-contrast. Image C: Sagittal T2, TR/TE - 5000/94ms, 5mm slice thickness, 384 × 256 matrix, non-contrast.)

Figure 4

Carotico-cavernous fistula in a 55 year old male who presented with chemosis, pulsatile exophthalmos and an orbital bruit. Stack of contrast enhanced axial CT images showing prominent left orbital veins (in the superior extra-conal compartment) draining into an engorged left cavernous sinus (white arrows). The left superior ophthalmic vein (black arrow) best seen in image C is tortuous and dilated. The constellation of findings is pathognomonic for carotico-cavernous fistula. (Protocol: GE BrightSpeed Elite 16 Slice CT, at 400mA and 120kV, 0.6mm slice thickness, Omnipaque 300 - 50mls i.v.).

Figure 5

Pre-septal orbital cellulitis (image A) in a 19 year old male seen as soft tissue swelling (white arrow) and adjacent fat stranding on this non-enhanced axial CT. Images B and C are from a 25 year old female who presented with chronic sinusitis and orbital cellulitis complicated by post-septal extension and formation of a sub-periosteal abscess (black arrow). Note the opacification of the right maxillary and ethmoidal airr cells in images B and C. (Protocol: Image A: Siemens Sensation 16 Slice CT, at 215mA and 120kV, 1mm slice thickness, non contrast. Image B: GE BrightSpeed Elite 16 Slice CT, at 134mA and 120kV, 2mm slice thickness, non contrast).

Figure 6

Choroidal tuberculoma in a 22 year old immunocompromised male with a past history of primary pulmonary tuberculosis. Sequential contrast enhanced axial CT images in a cranio-caudal direction (images A to C) demonstrate an ill defined lesion in the posterolateral aspect of the left globe. Ophthalmic examination revealed an elevated choroidal lesion and a diagnosis of choroidal tuberculoma was proposed. The lesion size decreased dramatically following the administration of anti-tuberculous treatment. (Protocol: Siemens Sensation 16 Slice CT, at 185mA and 120kV, 1mm slice thickness, Omnipaque 300 - 70mls i.v.).

Figure 7

Orbital pseudotumour in a 77 year old male who presented with painful unilateral exophthalmos. Axial (images A and C) and coronal (images B and D) orbital MR images reveal a diffuse inflammatory process involving the retro-bulbar fat (arrow) and the conal muscles (arrowhead) which causes right-sided proptosis (appreciated better on the axial images). The fat stranding gives a ‘dirty fat’ appearance (arrow) and mild enhancement is seen following the administration of contrast (image D). The imaging appearances are non-specific and orbital pseudotumour remains a diagnosis of exclusion. (Protocol: GE Signa EXCITE 1.5T MRI. Image A: Axial T2, TR/TE - 4400/76ms, 3mm slice thickness, 256 × 224 matrix, non-contrast. Image B: Coronal T1, TR/TE - 420/12ms, 3mm slice thickness, 288 × 256 matrix, non-contrast. Image C: Axial T1, TR/TE - 580/10ms, 3mm slice thickness, 256 × 224 matrix, Gadavist: 0.1 mmol/kg. Image D: Coronal T1, TR/TE - 580/10ms, 3mm slice thickness, 256 × 224 matrix, Gadavist: 0.1 mmol/kg.)

Figure 8

28 year old woman with a first episode of optic neuritis, who presented with acute onset of right eye pain and vision decline. The diagnosis was made clinically and MRI was performed as part of a full multiple sclerosis workup. The right optic nerve is relatively swollen compared to the left and has a focus of increased signal on T2 weighted imaging (arrowhead - image A). Pre- and post- contrast T1 axial (images B and C) and coronal (images E and F respectively) sequences demonstrate fusiform swelling of the right optic nerve with definite enhancement of the intra-orbital portion. Increased signal within the optic nerve is also seen on the FLAIR sequence (image D). (Protocol: MAGNETOM Symphony TIM 1.5T MRI. Image A: Axial T2, TR/TE - 4500/97ms, 5mm slice thickness, 448 × 306 matrix, non-contrast. Image B: Axial T1, TR/TE - 550/9ms, 5mm slice thickness, 256 × 256 matrix, non-contrast. Image C: Axial T1, TR/TE - 699/17ms, 3mm slice thickness, 320 × 240 matrix, Gadavist: 0.1 mmol/kg. Image D: Axial FLAIR, TR/TE - 9340/156ms, 5mm slice thickness, 256 × 204 matrix, non-contrast. Image E: Coronal T1, TR/TE - 699/17ms, 3mm slice thickness, 320 × 240 matrix, non-contrast. Image F: Coronal T1, TR/TE - 699/17ms, 3mm slice thickness, 320 × 240 matrix, Gadavist: 0.1 mmol/kg.)

Figure 9

Thyroid orbitopathy in a 58 year old female. Axial (images A and B) and reconstructed coronal (image C) CT images show bilateral exophthalmos. The medial (arrow) and inferior recti muscles are enlarged and symmetrically affected (as seen on the coronal image). Mild retro-bulbar fat stranding is noted bilaterally. The muscle tendons are spared resulting in a characteristic ‘Coca-Cola bottle’ sign (arrow). The radiological apperances are characteristic of thyroid orbitopathy. (Protocol: Siemens Sensation 16 Slice CT, at 179mA and 120kV, 1mm slice thickness, non contrast).

Figure 10

Axial non-enhanced CT images in a 45 year old male patient with hyperparathyroidism. Characteristic coarse calcifications are seen at the corneo-scleral junctions (arrowhead - image A). Heavy linear calcifications of the falx cerebri and tentorium cerebelli (arrows) are also seen. (Protocol: GE BrightSpeed Elite 16, at 118mA and 120kV, 2mm slice thickness, non contrast).

Figure 11

Choroidal melanoma in a 64 year old female. Non-enhanced axial CT image showing an oval shaped hyperdense choroidal lesion in the medial aspect of the right globe (arrowhead). Fine-needle biopsy confirmed a primary choroidal melanoma. There was no evidence of metastatic spread following imaging for staging workup. (Protocol: Siemens Definition AS 128 Slice CT, at 99mA and 120kV, 1mm slice thickness, non contrast).

Figure 12

68 year old female with a known diagnosis of neurofibromatosis type-1, who presented with a short history of decreased left eye vision. Pre- and post- contrast axial T1 sequences (images A and B respectively) demonstrate asymmetrical enlargement of the intra-orbital portion of left optic nerve (arrow) with no significant enhancement. Coronal T1 and T2 weighted images (C and D) show increased cross sectional area of the affected nerve (arrowhead), with increased central T2 signal. The optic chiasm is uninvolved. Images E and F are from a 43 year old man with mild right sided proptosis and deteriorating vision. Sequential T1 coronal images show a massively enlarged right optic nerve (arrow). The diagnosis of optic nerve glioma was confirmed histologically in both patients. (Protocol: Images A–D: Siemens MAGNETOM Avanto 1.5T MRI. Image A: Coronal T2, TR/TE - 382/9ms, 3mm slice thickness, 384 × 216 matrix, non-contrast. Image B: Axial T1, TR/TE - 382/9ms, 3mm slice thickness, 384 × 216 matrix, Gadavist: 0.1 mmol/kg. Image C: Coronal T1, TR/TE - 474/8ms, 3mm slice thickness, 256 × 144 matrix, Gadavist: 0.1 mmol/kg. Image D: Coronal T2, TR/TE - 4180/100ms, 3mm slice thickness, 320 × 180 matrix, non-contrast. Images E & F: GE Signa EXCITE 1.5T MRI. Coronal T1, TR/TE - 2253/9ms, 5mm slice thickness, 256 × 224 matrix, non-contrast.)

Figure 13

Incidental optic nerve sheath meningioma in a 55 year old female. Fusiform enlargement of the left optic nerve (arrowheads) in seen on axial T2 (image A) and T1 (image B) weighted images. Avid circumferential enhancement of the optic nerve sheath is demonstrated on the contrast enhanced coronal T1 sequence (image C) resulting in characteristic ‘tram-track’ enhancement (arrow - image D). (Protocol: Siemens MAGNETOM Avanto 1.5T MRI. Image A: Axial T2, TR/TE - 5000/89ms, 5mm slice thickness, 384 × 261 matrix, non contrast. Image B: Axial T1, TR/TE - 500/8ms, 3.5mm slice thickness, 256 × 224 matrix, non contrast. Image C: Coronal T1, TR/TE - 538/9ms, 4mm slice thickness, 384 × 216 matrix, Gadavist: 0.1 mmol/kg. Image D: Axial T1, TR/TE - 500/11ms, 3.5mm slice thickness, 256 × 209 matrix, Gadavist: 0.1 mmol/kg.)

Figure 14

Biopsy proven non-Hodgkin’s lymphoma in a 48 year old female patient who presented with symptoms secondary to obstruction of the right nasolacrimal duct. An ill defined soft tissue density lesion is seen at the infero-medial aspect of the right orbit (arrow - image A). There is no evidence of associated bone destruction (image B). (Protocol: Siemens Sensation 16 Slice CT, at 50mA and 120kV, 1mm slice thickness, Omnipaque 300 - 50mls i.v.).

Figure 15

Adenoid cystic carcinoma of the lacrimal gland in a 33 year old female, who presented with exophthalmos and diplopia. The lesion is isointense to muscle on CT (arrow - image A) and bulges out from the right lacrimal fossa, to displace the right superior rectus muscle medially. It appears as a lobulated, heterogeneous high signal intensity lesion on T2 sequences (images B and D) and is isointense to muscle on T1 (image E). Avid enhancement followed contrast administration (images C and F). The diagnosis was confirmed histologically. (Protocol: Image A: Siemens Definition AS 128 Slice CT, at 36mA and 120kV, 2mm slice thickness, Omnipaque 300 - 70mls i.v. Images B - F: MAGNETOM Symphony TIM 1.5T MRI. Image B: Axial T2, TR/TE - 4550/97ms, 5mm slice thickness, 448 × 306 matrix, non-contrast. Image C: Axial T1, TR/TE - 699/17ms, 3mm slice thickness, 320 × 240 matrix, Gadavist: 0.1 mmol/kg. Image D: Coronal T2, TR/TE - 4000/85ms, 3mm slice thickness, 384 × 288 matrix, non-contrast. Image E: Coronal T1, TR/TE - 792/14ms, 3mm slice thickness, 320 × 240 matrix, non-contrast. Image F: Coronal T1, TR/TE - 792/17ms, 3mm slice thickness, 320 × 240 matrix, Gadavist: 0.1 mmol/kg.)

Figure 16

Incidental CT finding of a lacrimal gland cyst (dacryops) in a 49 year old male seen as a cystic lesion arising from the palpebral lobe of the right lacrimal gland. The patient experienced swelling of the lateral aspect of his right eyelid, which fluctuated in size. The mean density measured with the placement of a ROI was 11.2HU in keeping with fluid. Diagnosis was confirmed after ophthalmic examination. (Protocol: Siemens Definition AS 128 Slice CT, at 99mA and 120kV, 1mm slice thickness, non contrast).

Figure 17

Biopsy proven basal cell carcinomas of the medial canthus in a 69 year old male (images A and B) and an 81 year old male patient (images C and D). Imaging in both cases was performed for staging and operative planning. Extensive exophytic growth (arrowhead) of the tumour is seen on images A and B (arrowhead). The tumour extends into the post septal space along the medial wall of the right orbit and demonstrates marked contrast enhancement. Less extensive involvement of the left medial canthus (arrow) is seen in the second patient (images C and D). Similar imaging characteristics are demonstrated. (Protocol: Images A & B: Siemens MAGNETOM Avanto 1.5T. Image A: Axial T1, TR/TE - 500/8ms, 3.5mm slice thickness, 256 × 224 matrix, non-contrast. Image B: Axial T1, TR/TE - 645/11ms, 3.5mm slice thickness, 256 × 209 matrix, Gadavist: 0.1 mmol/kg. Images C & D: MAGNETOM Symphony TIM 1.5T MRI. Image C: Axial T1, TR/TE - 500/14ms, 3mm slice thickness, 256 ×192 matrix, non contrast. Image D: Axial T1, TR/TE - 639/12ms, 3mm slice thickness, 256 × 192 matrix, Gadavist: 0.1 mmol/kg.)

Figure 18

Axial CT images of an 82 year old man with orbital renal cell carcinoma metastasis. The patient complained of increasing left orbital pain and proptosis. A soft tissue density mass (arrow - image A) is seen in the left orbital apex, which displaces the globe anteriorly. It causes adjacent bone erosion (arrowheads - images B and C) and extends medially to invade the ethmoid air cells. (Protocol: Siemens Sensation 16 Slice CT, at 212mA and 120kV, 1mm slice thickness, non contrast).

Figure 19

Coronal (images A to C) and axial (images D to F) MR images of a 5 year old child diagnosed with stage 4 neuroblastoma. An enhancing lesion is seen (arrows) within the left sphenoid wing which causes bony expansion and destruction. The lesion extends into the lateral aspect of the left orbit causing moderate exophtalmos due to mass effect. A second metastatic deposit with similar radiological appearances is seen in the right frontal calvarium. Findings are in keeping with neuroblastoma metastasis. (Protocol: GE Signa EXCITE 1.5T MRI. Image A: Coronal T2, TR/TE - 4400/79ms, 3mm slice thickness, 256 × 224 matrix, non-contrast. Image B: Coronal T1, TR/TE - 420/12ms, 3mm slice thickness, 288 × 256 matrix, non-contrast. Image C: Coronal T1, TR/TE - 2377/9ms, 4mm slice thickness, 256 × 224 matrix, Gadavist: 0.1 mmol/kg. Image D: Axial T2, TR/TE - 4400/79ms, 3mm slice thickness, 256 × 224 matrix, non-contrast. Image E: Axial T1, TR/TE - 2347/9ms, 4mm slice thickness, 256 × 192 matrix, Gadavist: 0.1 mmol/kg. Image F: Axial T2, TR/TE - 320/224ms, 5mm slice thickness, 320 × 224 matrix, non-contrast.)

Figure 20

Ethmoid (images A and B) and frontal (images C and D) mucoceles in a 25 year old and a 49 year old male patient respectively. Both patients had a history of chronic sinusitis. The anterior ethmoid air cells are expanded with inflammatory tissues and areas of complete bone resorption (arrow - image A) are evident. The visualized paranasal sinuses are completely opacified in the second patient. A superior left orbital lesion (arrow - image C) maintains direct communication with the left frontal sinus (arrowhead - image D). The imaging findings are characteristic of mucoceles. (Protocol: Images A & B: Siemens Definition AS 128 Slice CT, at 36mA and 120kV, 1mm slice thickness, non contrast. Images C & D: Philips Brilliance 16 slice CT, at 83mA and 120kV, 2mm slice thickness, non contrast).

Figure 21

Fibrous dysplasia in a 64 year old female. Axial CT (images A and B) shows left exophthalmos secondary to bony expansion of the left sphenoid wing (arrow). A ground-glass pattern (arrowhead) characteristic of fibrous dysplasia is seen on bone window settings with no evidence of bone destruction. The rest of the base of skull bones are unaffected. Incidental note is made of bilateral opacified ethmoid air cells. (Protocol: Siemens Sensation 16 Slice CT, at 310mA and 120kV, 4.5mm slice thickness, Omnipaque 300 - 70mls i.v.).

Figure 22

Right sphenoid wing meningioma in a 58 year old female patient who presented with deteriorating vision and proptosis. The meningioma resides in the anterior aspect of the middle cranial fossa and enhances avidly and homogenously after contrast administration (arrow - image B). There is extensive reactive hyperostosis of the adjacent right sphenoid wing involving the lateral orbital wall (arrowhead). (Protocol: Siemens Emotion 6 slice CT, at 160mA and 130kV, 3mm slice thickness, Omnipaque 300 - 60mls i.v.).

Figure 23

42 year old female with a family history of neurofibromatosis type 1. The patient had previous enucleation for optic nerve glioma and an ocular prosthesis is noted within the right orbit. There is severe dysplasia of the right sphenoid bone (arrow - image A) resulting in marked bony deformity of the right orbit. A plexiform neurofibroma (arrowheads - images B to D) is noted over the right fronto-temporal region, which enhances markedly after contrast administration. The constellation of imaging findings is pathognomonic of neurofibromatosis type 1. (Protocol: Siemens MAGNETOM Avanto 1.5T. Image A: Axial T2, TR/TE - 3620/98ms, 5mm slice thickness, 320 × 320 matrix, non-contrast. Image B: Coronal T2, TR/TE - 4000/102ms, 3.5mm slice thickness, 448 × 355 matrix, non-contrast. Image C: Axial FLAIR, TR/TE - 8000/98ms, 5mm slice thickness, 320 × 256 matrix, non-contrast. Image D: Axial T1, TR/TE - 500/11ms, 3.5mm slice thickness, 256 × 209 matrix, Gadavist: 0.1 mmol/kg.)

Figure 24

Intraocular penetration by a wire fence in a 38 year old male. The loose end of the wire traversed the anterior chamber, penetrated the lens (arrow - image A), and caused a linear vitreous hemorrhage along its path (arrowhead - image B). The globe contour is maintained and traumatic pre-septal soft tissue swelling is noted. (Protocol: Siemens Sensation 16 Slice CT, at 187mA and 120kV, 1mm slice thickness, non contrast).

Figure 25

Traumatic globe rupture in a 29 year old male patient. CT shows collapse of the left globe with a characteristic ‘flat tyre’ appearance. There is no evidence of intra-ocular air or foreign body. Typical thickening of the posterior sclera is seen (arrow - image A) and the left globe has a hazy outline (arrowhead - image B). (Protocol: Siemens Definition AS 128 Slice CT, at 193mA and 120kV, 5mm slice thickness, non contrast).

Figure 26

Traumatic dislocation of the lens in a 77 year old male passenger involved in a road traffic accident. Axial CT images demonstate the left lens to be floating within the vitreous humor (arrowhead - images B and C). The globe contour is preserved and there were no external features of ocular injury. The diagnosis of traumatic dislocation of the lens was confirmed on ophthalmic examination. The uninjured right globe is shown for comparison (image A). (Protocol: GE HiSpeed CT Dual, at 95mA and 120kV, 4mm slice thickness, non contrast).

Figure 27

Rhegmatogenous retinal detachment in a 49 year old female who presented with deteriorating vision after injury in contact sports. The intraocular contents appear hyperintense on FLAIR (image A) in keeping with an extensive vitreous hemorrhage. The leading edge of an associated retinal detachment (arrow) is seen as a linear hypointensity within the left posterior chamber. A fluid- fluid level is seen in the sub-retinal space (arrowhead - image B) and represents layering of blood products. A tiny retinal tear (diagnosed on ophthalmic examination) allows vitreous fluid to seep through it and accumulate in the potential space between the neurosensory retina and the underlying retinal pigment epithelium. Clinical and imaging findings support a diagnosis of rhegmatogenous retinal detachment secondary to traumatic vitreo-retinal traction. (Protocol: GE Signa EXCITE 1.5T MRI. Image A: Axial FLAIR, TR/TE - 8502/162ms, 6mm slice thickness, 320 × 224 matrix, non-contrast. Image B: Axial T2, TR/TE - 512/256ms, 6mm slice thickness, 512 × 256 matrix, non-contrast. Image C: Sagittal T2, TR/TE - 5000/94ms, 5mm slice thickness, 384 × 256 matrix, non-contrast.)

Figure 28

Blow-out fracture in a 29 year old woman. A ‘teardrop’ sign (arrow - image A) is seen on the frontal radiograph acquired after facial trauma and represents orbital fat herniation through the orbital floor defect. This right inferior orbital margin appears intact, and the density projecting over the superior aspect of the right maxillary sinus represents intraocular fat herniation through an orbital floor fracture. Axial CT in bone window settings (image B) confirms a right orbital floor fracture and the presence of air bubbles (arrowhead) in the orbit due to communication with the underlying sinus. The inferior rectus muscle (arrowhead - image C) was not entrapped in the fracture, and retro-orbital fat herniation (arrow) is again seen on this coronal reconstruction. The imaging findings are in keeping with a ‘blow-out’ fracture of the right orbit. (Protocol: Images B & C: GE HiSpeed CT Dual, at 95mA and 120kV, 4mm slice thickness, non contrast).

Figure 29

Orbital foreign bodies in three different patients. Streak artifact caused by a metallic foreign body (arrow - image A) in the retro-bulbar space in a patient with a history of pellet injury to the left orbit. A superficial foreign body is seen at the corneo-scleral junction (arrowhead - image B) of a patient who had sustained a welding injury. Image C shows an intra-ocular pellet. The right lens is slightly deformed but the globe maintains its contour and there is no evidence of an associated vitreous hemorrhage. (Protocol: Image A: Siemens Sensation 16 Slice CT, at 193mA and 120kV, 1mm slice thickness, non contrast. Image B: Siemens Sensation 16 Slice CT, at 233mA and 120kV, 1mm slice thickness, non contrast. Image C: Siemens Definition AS 128 Slice CT, at 99mA and 120kV, 1mm slice thickness, non contrast).

Figure 30

Phthisis bulbi in a 45 year old blind male patient with previous ocular trauma. Axial CT in bone algorithm (images A and B) demonstate a shrunken right (microphthalmia) and dense sclero-choroidal calcifications in keeping with phthisis bulbi. (Protocol: Siemens Sensation 16 Slice CT, at 150mA and 120kV, 1mm slice thickness, non contrast).

Figure 31

Non-contrast CT scan through the orbits demonstrates a prosthetic left eye (arrow - image A) in a 25 year old man. The prosthesis is seen as a high density rounded structure replacing the left globe. Enucleation removes the globe leaving the extra-ocular muscles and remaining orbital contents intact (image B). (Protocol: Siemens Sensation 16 Slice CT, at 310mA and 120kV, 4.5mm slice thickness, non contrast).

Figure 32

Axial T2 and contrast enhanced T1 MR (images A and B respectively) in a 55 year old man previously treated with orbital exenteration for an invasive basal cell carcinoma. There is evidence of total left exenteration (arrow) with removal of all orbital contents including the periorbita and eyelids. (Protocol: Siemens MAGNETOM Avanto 1.5T. Image A: Axial T2, TR/TE - 5000/89ms, 5mm slice thickness, 384 × 261 matrix, non-contrast. Image B: Axial T1, TR/TE - 500/11ms, 3.5mm slice thickness, 256 × 209 matrix, Gadavist: 0.1 mmol/kg).

Figure 33

Axial non enhanced CT (images A and B) obtained in a 85 year old woman demonstrates air within the right anterior chamber (arrows) following cataract surgery. Axial T2 weighted MR in a second patient shows a left lens implant (arrows) for the treatment of cataracts (arrow - image C). The normal right lens (arrowhead - image D) is shown for comparison. (Protocol: Images A & B: GE HiSpeed CT Dual, at 125mA and 120kV, 4mm slice thickness, non contrast. Images C & D: GE Signa EXCITE 1.5T MRI. Axial T2, TR/TE - 4900/97ms, 5mm slice thickness, 384 × 256 matrix, non-contrast).

Figure 34

Non enhanced CT (images A and B) in a 45 year old female shows an incidental finding of bilateral small rounded calcifications on the optic disc surfaces (arrows) characteristic of optic nerve drusen. (Protocol: Siemens Sensation 16 Slice CT, at 310mA and 120kV, 4.5mm slice thickness, non contrast).

Figure 35

Bilateral optic disc colobomas in a 80 year old male patient. The optic nerve heads are displaced posteriorly and there is ‘funnel-shaped’ excavation (arrow - image A) of the posterior fundus. The sclera at the margin of the defect is thinned and everted. (Protocol: Siemens Symphony 1.5T MRI. Image A: Axial T1, TR/TE - 699/17ms, 3mm slice thickness, 320 × 240 matrix, non-contrast. Image B: Axial T2, TR/TE - 4550/97ms, 5mm slice thickness, 448 × 306 matrix, non-contrast. Image C: Axial FLAIR, TR/TE - 9340/156ms, 5mm slice thickness, 256 × 204 matrix, non-contrast).

Figure 36

Staphyloma in a 34 year old female who presented with progressive myopia. Axial CT (images A and B) shows elongation of the right globe (along its axis) due to focal posterior deformity (arrow). No abnormal enhancement in the uveo-sclera was seen post contrast administration. The structural alterations of the globe are characteristic of posterior staphyloma. (Protocol: Siemens Emotion 6 slice CT, at 60mA and 130kV, 3mm slice thickness, non contrast).