WIDI - CA0284-Penetrating Orbital/Ocular Injury 1, CT

Penetrating Orbital/Ocular Injury 1, CT

Claim CME Credit

0.5 CME Credit available on completion

POINT OF CARE INFORMATION

This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.

Learning Objectives

As a result of participation in this activity, participants should be able to:

Provide improved patient care.
Greater knowledge of the imaging characteristics of the patient's disease.
Understand a better approach to interpretation of studies.

Faculty Disclosure

Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.

CME Advisory Committee Disclosure:

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.

Continuing Medical Education Credit

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CA0284-Penetrating Orbital/Ocular Injury 1, CT

History

36 year old male in the emergency room with penetrating injury of the eye and orbit.

Exam

Non-contrast CT of the maxillofacial region was obtained with 0.5-1.0 mm thick sections in the axial, reformatted in the coronal and sagittal planes and viewed interactively in 3 dimensions at the computer workstation.

Findings

Preseptal Soft tissues and Orbital Adnexa

The left preseptal soft tissues including the eyelids and conjunctival sac are swollen/edematous.

There are 3 collections of air on the left one is mesial and superior and could be just under the eyelid but could be within the sclera. A second is obviously within the soft tissues of the eyelid medially. A third is present along the inferior margin of the globe just anterior to the inferior oblique muscle and could also represent a non-radiopaque foreign bodies lodged in the sclera.

There is no radiodense foreign body in areas of soft tissue swelling or elsewhere.

Eyes and Optic nerves

The eye is not decompressed or enlarged. The anterior chamber is markedly reduced in size. The lens position is abnormal on the left side due to the anterior chamber decompression and this suggests corneal injury.

There is no evidence of a subretinal, subchoroidal, subhyaloid or intravitreous hemorrhage or other fluid collection. There is no evidence of hemorrhage in or along the optic nerve and/or sheath.

Orbits

There is no abnormal air collection in the postseptal extraconal or intraconal orbital compartments likely due to this penetrating injury. The extraconal and/or intraconal orbital fat is normal.

The bones of the orbit including the optic canal are normal.

Brain

There are no intra-axial or extra-axial abnormalities of the brain that might be related to the eye/orbital pathology.

Other findings

There are no other significant abnormalities present.

Impression

Penetrating orbital trauma with anterior segment decompression and possible retained foreign bodies embedded in the sclera - extent of injury described above. The spectrum of findings also suggests corneal injury.

Recommendations

Direct, verbal communication was initiated with the EMS and ophthalmology service due to explain the risks of corneal injury if definitive physical exam was not possible and ore full explain possibility of scleral foreign bodies.