Diagnostic value of computed tomography in predicting open globe injury

The aim of the study to investigate the compatibility between ophthalmological findings and orbital CT and the diagnostic value of orbital CT in open globe injuries.

Medical and surgical records of patients with suspected ocular trauma who underwent orbital CT were reviewed. Radiological data including orbital fracture, emphysema and hemorrhage, globe asymmetry, posterior scleral flattening, irregular scleral contour, intraocular free air, vitreous and choroidal hemorrhage, lens disruption, anterior chamber depth, location of penetration were reviewed by two radiologists.

Of the 116 eyes, 47 (40.5%) were open globe and 69 (59.5%) were closed globe injury. Visual acuity and ocular trauma score were lower and hyphema, lens problems, vitreous hemorrhage (VH), retinal and choroidal detachment were higher in the open globe compared to closed globe injuries. The sensitivity, specifity, positive and negative predictive values were 53.2%, 97.1%, 92.6% and 75.3%, respectively. In radiologically open globe injuries, globe asymmetry, posterior scleral flattening, irregular scleral contour, intraocular free air and VH was higher compared to the false negative group (p = 0.001, p = 0.002, p = 0.001, p = 0.01, p = 0.002 respectively). The aferomentioned radiological findings were associated with low initial visual acuity.

Irregular scleral contour, globe asymmetry, VH, posterior scleral flattening and intraocular air are the most valuable radiological findings in the diagnosis of open globe injury. The presence of these findings was associated with poor visual acuity. The sensitivity of orbital CT is low, and ophthalmologic examination should be performed to confirm whether there is an open globe injury. Trial registration number and date 872/ 11.07.2023, Ethics Committee of Kayseri City Hospital, retrospectively registered.