Don't Rely on CT to Rule Out Open Globe

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CT was specific for open globe but not sensitive.  The best CT predictors of open globe were change in globe contour and vitreous hemorrhage.  Open globe is a clinical or surgical diagnosis.  CT alone can't rule it out.

Why does this matter?
If you rely on orbit CT as your screening test for open globe, you will miss open globe cases.  See the common clinical findings below.  If you see these, call ophthalmology even if the CT is "negative."

You'll shoot your eye out, kid.
This was a retrospective look at 114 cases of eye trauma, 39 of which had clinically or surgically confirmed open globe; the rest did not.  One neuroradiologist and two ophthalmologists read CTs and were blinded to clinical information.  Specificity for open globe was >97%, but sensitivity was poor, ranging from 51-77%.  Keep in mind, this is the diagnostic accuracy of 3 people for this study, so it may not be representative.  CT was done with a 40-slice scanner, so you may have better images than those used for this study.  Overall, this supports that open globe is a clinical or surgical diagnosis and is not ruled out with CT.  Clinical signs of scleral rupture are, "poor visual acuity, afferent pupillary defect (APD), chemosis, hyphema, and hypotony."  Hyphema and APD are particularly important physical exam findings for open globe.  Remember, ocular ultrasound is contraindicated if you suspect open globe.

Source
Accuracy of Computed Tomography Imaging Criteria in the Diagnosis of Adult Open Globe Injuries by Neuroradiology and Ophthalmology.  Acad Emerg Med. 2017 Jun 29. doi: 10.1111/acem.13249. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.