A systematic approach to CT evaluation of orbital trauma.

Computed tomography (CT) is widely used in the initial evaluation of patients with craniofacial trauma. Due to anatomical proximity, craniofacial trauma often involves concomitant injury to the eye and orbit. These injuries may have devastating consequences to vision, ocular motility, and cosmesis. CT imaging provides a rapid and detailed evaluation of bony structures and soft tissues of the orbit, is sensitive in detection of orbital foreign bodies, and often guides clinical and surgical management decisions in orbital trauma. For this reason, radiologists should be prepared to rapidly recognize common orbital fracture patterns, accurately describe soft tissue injuries of the orbit, detect and localize retained foreign bodies within the globe and orbit, and recognize abnormalities of the contents and integrity of the globe. In this review, we present a systematic approach to assist radiologists in the rapid evaluation of orbital trauma using the "BALPINE" mnemonic-bones, anterior chamber, lens, posterior globe structures, intraconal orbit, neurovascular structures, and extraocular muscles/extraconal orbit. Using this approach, we describe common traumatic findings within each of these spaces, and present common postsurgical appearances that can mimic findings of acute trauma.

Odontogenic orbital cellulitis.

PURPOSE: To describe a small series of patients with odontogenic orbital cellulitis and review the visual outcomes of such patients reported in the scientific literature. METHODS: Review of medical records and the scientific literature. Measured parameters included gender, age, days to presentation and surgery, the need for surgical intervention(s), sinus and orbital involvement on CT imaging, and pathogens involved. RESULTS: Current cases and review of the scientific literature resulted in 24 patients with odontogenic orbital cellulitis and adequate examinations for statistical analysis. Twelve of 24 patients had preserved vision (final vision better than 20/70), whereas 11 of 24 patients had vision loss (final vision of light perception or no light perception). Analysis of data showed no statistical correlation between visual loss and age (p = 0.81), days to clinical presentation (p = 0.45), days to surgical exploration (p = 0.96), sinus radiographic involvement (p = 0.50), orbital radiographic findings (p = 0.19), or type of bacterial infection (Gram-positive aerobic vs. anaerobic organisms), (p = 0.31 and p = 0.50 respectively). Male gender, the need for surgical drainage, and multiple surgical procedures performed correlated statistically with loss of vision (p = 0.05, p = 0.03, and p = 0.02, respectively). CONCLUSIONS: Multiple case reports have demonstrated that orbital cellulitis from an odontogenic source can result in devastating visual loss. Male gender, the need for surgical drainage, and multiple surgical procedures correlated statistically with severity of visual loss.

Palpebral subconjunctival hemorrhages in herpes zoster ophthalmicus.

A 75-year-old previously healthy woman was referred for evaluation of pain and foreign body sensation in her left eye of 4 days' duration. Two weeks before presentation she was diagnosed with herpes zoster involving the left forehead and temple area and started on famciclovir treatment. Examination of her left cornea revealed inferior superficial punctate keratitis, but no dendrites or pseudodendrites. Upper eyelid eversion disclosed unusual raised palpebral subconjunctival hemorrhages on the left side. She was started on topical prednisolone eyedrops in the left eye, and her symptoms improved over the following week. Herpes zoster ophthalmicus can initially present in the eyelids. Careful follow-up with particular attention to the eyelids and eyelid eversion is recommended in any patient presenting with herpes zoster to detect early ocular involvement.