Ocular and Optic Nerve/Sheath Trauma: Penetrating and Foreign Body

History

Orbital trauma with possible blunt or penetrating ocular (eye)/optic nerve injury or retained foreign body.

Exam

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

MRI- T1 and T2 weighted images were done in the axial coronal plane with high-resolution techniques focused on the eye and orbits and anterior and visual pathways. These include fat-suppressed and images following the intravenous administration of a paramagnetic contrast agent.

Prior Study

N/A

Findings

Preseptal Soft tissues and Orbital Adnexa

The preseptal soft tissues including the eyelids, conjunctival sacs, lacrimal gland and lacrimal sac regions are swollen/edematous. [Yes/No]

There is an abnormal air collection in the preseptal soft tissues including the eyelids, conjunctival sacs, lacrimal gland and lacrimal sac regions likely due to a blunt or penetrating injury. [Yes/No]

There is a slightly or obviously radiodense foreign body in areas of soft tissue swelling or elsewhere. [Yes/No]

There is an air (low density) pattern, either a tract or “geometrically shaped”, suggestive of a penetrating injury in areas of soft tissue swelling or elsewhere. [Yes/No]

There is one or more “geometrically shaped” low density structures suggestive of a non radiodense foreign body presence. [Yes/No]

Eyes and Optic nerves

The eye is decompressed or enlarged. [Yes/No]

The shape or size of the eye is otherwise abnormal. [Yes/No]

The anterior chamber is abnormally large or reduced in size. [Yes/No]

There is evidence for a hyphema. [Yes/No]

The lens position is abnormal on either side. [Yes/No]

The anterior segment structures of the eye are otherwise abnormal. [Yes/No]

There is evidence of a subretinal, subchoroidal, subhyaloid or intravitreous hemorrhage or other fluid collection. [Yes/No]

The junctions of the optic sheath/nerve and eye are abnormal. [Yes/No]

Proptosis or enophthalmos is present. [Yes/No]

The optic sheath/nerve has a stretched appearance. [Yes/No]

The posterior aspect of the globe is tented in appearance. [Yes/No]

There is evidence of hemorrhage in or along the optic nerve and/or sheath. [Yes/No]

Signs of tension orbit are present. [Yes/No]

Orbits

There is an abnormal air collection in the postseptal extraconal or intraconal orbital compartments likely due to a blunt or penetrating injury. [Yes/No]

The bones of the orbit including the optic canal are abnormal. [Yes/No]

The extraconal and/or intraconal orbital fat is abnormal. [Yes/No]

The extraocular muscles, orbital apex and superior orbital fissure appear abnormal. [Yes/No]

Brain

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

Other findings

There are other significant abnormalities present. [Yes/No]

Impression

Penetrating - Occular and Optic Nerve/Sheath Trauma

1- Ocular/optic nerve injury [with/without] complications - extent described above.
2- Ocular /optic nerve injury [with/without] retained foreign body - extent described above.
3- Ocular/optic nerve injury with associated orbital and/or facial injury - extent described above.