The Bubble Eye Sign: Understanding the Radiological Imaging of Gas inside the Orbit

Area of Science:

• Ophthalmology
• Radiology
• Medical Imaging

Background:

• Intraocular gas, radiolucent on X-ray, is typically absent in the orbit.
• Retained intravitreal gas is used for tamponade during intraocular surgeries.
• Post-surgical falls are common due to altered stereopsis and patient positioning.

Purpose of the Study:

• To describe the "Bubble Eye sign" on skull X-ray.
• To differentiate intravitreal gas from orbital emphysema.
• To guide appropriate diagnostic pathways for patients with suspected orbital injury post-retinal surgery.

Main Methods:

• Analysis of characteristic radiographic findings on skull X-ray.
• Distinguishing features of intravitreal gas versus orbital emphysema.
• Clinical correlation with patient history and surgical interventions.

Main Results:

• Intravitreal gas presents as a distinct bubble outlining the globe on X-ray.
• Orbital emphysema appears as a superiorly located crescent or concave shape.
• The "Bubble Eye sign" reliably indicates iatrogenic intravitreal gas.

Conclusions:

• The "Bubble Eye sign" is a crucial indicator of retained intravitreal gas post-retinal surgery.
• Radiographic identification of this sign necessitates ophthalmological assessment.
• This avoids unnecessary radiation exposure from computed tomography scans for orbital fracture evaluation.