"Don't miss the globe" - Study of diagnostic accuracy of computed tomography in detecting open globe injury

Abstract

Purpose: The purpose is to determine the computed tomography (CT) characteristics of open globe injury and establish the relative accuracy and reliability of various features on CT. Second, to assess the significance of a difference in the anterior chamber depths (ACDs) on CT in cases of open globe injury.

Methods: The diagnostic database of our radiology department was retrospectively reviewed to obtain details of patients with a history of blunt or penetrating injury to the orbit between September 2018 and March 2021. A total of 190 patients (144 males and 46 females) were included. A radiologist analyzed the CT scans without prior knowledge of ophthalmologic findings or surgical outcomes. Operative and ophthalmic examination findings were considered the gold standard for comparison.

Results: Out of 190 injured globes, the final clinical diagnosis confirmed 54 (28.4%) open globe injuries and 136 (71.5%) closed globe injuries. Between the two groups, intraocular hemorrhage, lens dislocation, lens injury or absence, intraocular foreign body, intraocular air, wall/contour defect, and ACD change were considered statistically significant (P < 0.05). The average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in diagnosing open globe injury were 71.3%, 98.5%, 83.6%, 95.75%, and 94.9%, respectively.

Conclusion: Globe contour deformity or defect, intraocular hemorrhage, and a change in ACD were the three most predictive signs of open globe injury. CT is of valuable help in a multi-trauma setting and in an uncooperative patient for ophthalmological examination to draw attention to globe injury. However, CT examination alone is insufficient in detecting all cases of open globe injury. There is a need for a more collaborative approach among emergency physicians, ophthalmologists, and radiologists.

Keywords: Computed tomography; emergency medical services; penetrating eye injury.

Figure 1

A 25-year-old male with intraocular hemorrhage. Axial plain computed tomography shows intraocular hemorrhage involving anterior and posterior segments in the left globe. The red open arrow points to hemorrhage

Figure 2

A 35-year-old male with lens dislocation. Axial plain computed tomography shows anterior lens dislocation in the left globe. Red open arrow points to the anteriorly dislocated lens. White open arrow points to the normally positioned lens on the right side

Figure 3

A 33-year-old female with globe rupture. Coronal computed tomography shows intraocular metallic density foreign body in the left globe

Figure 4

A 27-year-old male with globe rupture. Axial plain computed tomography shows a deformed small left globe with air pockets, red open arrow points to the ruptured globe and the white open arrow points to the intraocular air

Figure 5

A 26-year-old male with right globe rupture. Plain axial computed tomography shows reduced volume of the right globe, black open arrow points to reduced volume of the right globe

Figure 6

A 43-year-old male with globe rupture left globe with reduced anterior chamber depth. Plain axial computed tomography shows reduced anterior chamber depth on the left side, shown by the black open arrow

Figure 7

A 23-year-old male with globe rupture. Axial plain computed tomography shows increased anterior chamber depth with vitreous hemorrhage in the left globe, shown by the large open black arrow. In comparison, increased anterior chamber depth shown by a smaller black open arrow

Figure 8

(a) False-positive diagnosis of globe rupture on computed tomography scan of a 38-year-old female. Coronal unenhanced computed tomography scan shows likely a foreign body within the left globe indicative of globe rupture (black open arrow). On surgery, the foreign body was on the surface of the globe, no evidence of rupture. (b) False-positive diagnosis of globe ruptures on computed tomography scan of a 38-year-old female. Axial unenhanced computed tomography scan shows likely foreign body within the left globe indicative of globe rupture (black open arrow). On surgery, foreign body was on the surface of the globe, with no evidence of rupture

Figure 9

(a) False-positive diagnosis of globe rupture on computed tomography scan of a 30-year-old male. A plain coronal computed tomography scan demonstrates intraocular air shown by white arrow, indicative of globe rupture. There was no globe rupture on computed tomography, indicating that computed tomography appearance was artifact. (b) False-positive diagnosis of globe ruptures on computed tomography scan of a 30-year-old male. Plain sagittal computed tomography scan demonstrates intraocular air shown by white arrow, indicative of globe rupture. There was no globe rupture on computed tomography, indicating appearance was artifact