gms | German Medical Science

Purpose: To evaluate the significance of orbital CT scans to detect penetrating eye injuries in cases of heavy ocular trauma associated with massive subconjunctival or anterior chamber hemorrhage.

Material and methods: In a retrospective chart review 59 patients presented with heavy ocular trauma of unsure rupture of the globe due to subconjunctival and / or anterior chamber hemorrhage while IOP was within normal range. High resolution multislice CT scans were performed in all patients. The affected eye was examined for penetrating injury signs as abnormal eye shape, scleral irregularities, lens dislocations or intravitreal hemorrhages. Surgical sclera inspections were performed in most of the cases with a negative CT to safely rule out a perforating eye injury.

Results: In 41 out of the 59 patients CT scans showed no signs of a penetrating eye injury, which could be confirmed by scleral inspection and ophthalmologic follow-up of the patients. In 12 patients a penetrating injury was diagnosed by CT and subsequent eye surgery confirmed the proper diagnosis. In one patient CT revealed signs of eye penetration while no scleral rupture was seen during subsequent surgery. In 5 patients a penetrating eye injury was treated by ocular surgery while preoperative CT scans failed to diagnose the open globe injury. Thus, in 53 out of 59 cases CT examination achieved correct diagnosis (90%); however, regarding the open globe cases proper diagnosis could only be achieved in about 70% (12/17).

Conclusion: In about one third of all unclear cases with a penetrating injury, CT evaluation failed to properly diagnose the open globe injury. Thus, a surgical sclera inspection is mandatory in such trauma cases independently from CT results.