2. Indications # Todistinguish normal from glaucomatous eves. # ‘To monitor disease progress 3. Display provides colour images of the optic nerve head and RNFL maps in the four quadrants (ig. 2.31) # The fandus image of the left and right eyes at the top is tasofl in identifving, image quality. © ‘The thickness maps are presented in a colour-coded specirum from blue to red. Red followed by yellow indicates a thick RNFL whereas blue followed by green shades are consistent with thin RNPL, The map has an hourglass appearance because the RNFL is thickest superiorly and inferiorly. * The deviation maps show the location and magnitude Of REL defects as tiny colar coded squares (pixels), © The TSNIT lemporal-superior-inferior-temporal) graph is displayed at the bottom, It shows the aetual values for that eye along with a shaded area tht represents the 959% normal range For that age. The curve in a healthy ‘eve should fall within the shaded area and has a double hump pattern because the superior and inferior fibres are thickest. The centeal printout shows the values for both eyes together * Parameters for each eve are displayed in a table (top centre}, The nerve libee indicator (NFI) at the bottom of the table indicates a global value based on the entire thickness map and is the optimal parameter for discrintinating normal from glaucoma. Normal is, 30, borderline is 31-50 and abnormal is 31-100, NEUROIMAGING Imaging techniques for visualizing the brain and orbit are evolving and improving and there are now a wide variety of tests available, It is very important to match the appropriate imaging study to the elinicall findings so that itis paramount for the ophthalmologist to provide the radiologist with the suspected differential diagnosis and localization of the presumed lesion. Computed tomography Physics Computed tomography (CT) uses x-ray beams to obtain tissue density values from which detailed cross-sectional images are: formed by a computer, Tissue density is represented by a 21 scale, white being maximum density (e.g. bone) and black, being minimum density (eg, alr). It is important to view: Images of the orbit in at least two planes; usually axial and coronal images are sullicient. Revent technical advance in CT has led to the wider use of multidetector (‘multislice’t scanners. These have the ability to acquire thinner slices leading to improved spatial resolution and faster examination times without proportionate increase in radiation dose Images are acquired in an axial form and can be viewed in any plane using computer reconstruction. This multiplanar information can be an advantage over magnetic resonatice imaging (MR) with regard to anatomical detail Contrast loginated contrast material improves sensitivity. and specificity but is contraindicated in patients allergic to iodine and those with renal failure. Contrast is not indicated in the assessment of acate haemorrhage, bony injury or local- ization of foreign bodies because it may mask visualization of these high density structures Indications CT is widely available, easy to perform, relatively inexpensive, takes only a few minutes and is generally well tolerated by claustrophobic patients. However, unlike MR it exposes the patient to ionizing radiation, The main indications for CP are as follows, |. Orbital trauma, for the detection of bony lesions such as fractures (Fig, 2.32a) and erosions, and demonstration of skull anatomy. Foreign bodies as well as blood. hecniation of extraocular muscles into the maxillary sinus and surgical emphysema can also be assessed, 2. Evaluation of the extraocular muscles in thyroid eve disease (Fig. 2.326), Although MR may also be of use, C is usually sufficient, 3. Bony involvement of orbital tumours is. heiter assessed using CT rather than MR, 4. Orbital cellulitis for assessment of intraorbital extension and subperiosteal abscess formation, 5. Detection of intraorbital calcification as in optic dist drusen, meningioma und retinoblastoma, 6. Detection of acute cerebral or subarachnoid haemorrhage (Fix. 2.32c and d) becwuse this is harder to visualize on MR in the first few hours, 7. Visual toss. As a quick and easily: available first-line Investigation in the assessment of visual loss in order to exclude a compressine lesion of the optic nerve, 8. When MR is contraindicated (ic, patients with ferrous foreign bodies) Magnetic resonance ima; Physics MRT depends on the rearrangement of hydrogen nuclet [protons — positively charged) when a tissue is exposed 10 a