Globe Injuries in Emergency Radiology

Matthew Lee MD Background

Joshua Genuth DMD Eye injuries are a common cause of vision impairment and blindness.
Radiologists may be the first to detect injuries to the globes as physical
Mikell Yuhasz MD examination may be limited by periorbital swelling, other injuries, or
Mark Bernstein MD patient cooperation. Depending on the nature of the trauma, multiple
Alexander Baxter MD types of injuries may coexist within the globe. Knowledge of the imaging
manifestations of ocular injuries is therefore essential for radiologists.
Sergey Kochkine MD

Normal Ocular Anatomy on CT

AC AC = anterior chamber
Learning Objectives L L = lens
• To review normal ocular anatomy on CT. PS = posterior segment
• To review different types of globe injuries. PS S = sclera
Ch = choroid
S/Ch/R MR R = retina
Disclosures: Authors have no disclosures LR = lateral rectus
LR
ON MR = medial rectus
ON = optic nerve
Target Audience: Radiologists, Ophthalmologists,
Emergency Medicine Physicians

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 Anterior Chamber Injuries
Corneal Laceration Hyphema
Case 1 Case 2 Case 3

The asymmetrically shallow right anterior chamber indicates a full-thickness

corneal laceration resulting in anterior chamber rupture.
The slight hypoattenuation of the right lens suggests a traumatic cataract. Hyphema refers to hemorrhage within the anterior chamber due to shearing of
vessels in the uvea.
Case 3 also features a partially dislocated lens.

Superficial corneal lacerations may not be visible on

imaging. However, deep lacerations may cause Anterior chamber injuries are often difficult to diagnose on imaging
leakage of aqueous humor and distort the cornea. but are usually readily apparent on physical exam.

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 Partial or complete tearing of the zonular fibers suspending Lens Injuries
the lens results in lens dislocation.
The lens almost always dislocates posteriorly because the iris
restricts anterior motion.
Complete Lens Dislocation
Zonular fibers
(suspensory ligaments)
connecting the lens to the
ciliary muscles may or may
not be barely visible on CT.

Partial Lens Dislocation

In complete lens dislocation, the lens falls to the dependent portion of the globe.

In partial lens dislocation, the lens is free on the side with torn
zonular fibers and fixed by the fibers that are still intact.
In this example, the left lens is slightly displaced posteriorly,
inferiorly, and to the left, indicating a partially dislocated lens.
The hyperdensity in the posterior left globe
represents a completely dislocated lens.
Additionally, the right globe is atrophic and
partially calcified, consistent with phthisis bulbi
(end-stage sequela of ocular injury).
On physical exam, the left cornea
is clouded, and the dislocated
lens is eccentrically located.
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 Posterior Segment Injuries
Vitreous Hemorrhage Retinal Detachment

Retinal detachment occurs when a tear in the retina allows vitreous

humor and blood to fill the space between the retina and choroid.
The retina’s posterior attachment to the optic disc may result in a V-shaped
detachment.

Choroidal Detachment

Choroidal detachment occurs

Vitreous hemorrhage, caused by disruption of retinal vessels, is seen when decreased intraocular
as hyperdense fluid in the posterior segment. pressure allows fluid or blood to
detach the choroid and appears
as lentiform or biconvex
When the volume of vitreous hemorrhage is large, it hyperdensity sparing the
may obscure other findings. Careful evaluation of the posterior globe.
globe margin is necessary to rule out globe rupture.
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 Globe rupture due to blunt trauma often
occurs behind the extraocular muscle
Globe Rupture
attachments where the sclera is weakest. Summary:
Knowledge and recognition of globe
injuries on CT imaging in the
Shallow anterior chamber emergency department is a crucial
Dislocated lens
skill for radiologists. While it is helpful
to conceptualize globe injuries by
anatomy, it is also important to
recognize that multiple types may
coexist within the globe.

References/Further Reading:
Globe rupture (or open-globe injury) refers to full-thickness disruption of the sclera or cornea. • Balakrishnan S, Harsini S, Reddy S, Tofighi S,
Direct signs include globe deformity or wall irregularity (“flat tire” sign), intraocular hemorrhage, and scleral discontinuity. Gholamrezanezhad A. Imaging review of ocular
Indirect signs include altered anterior chamber depth and intraocular air or foreign body. and optic nerve trauma. Emergency Radiology
2020; 27:75-85.
• Sung EK, Nadgir RN, Fujita A, Siegel C, Ghafouri
RH, Traband A, Sakai O. Injuries of the Globe:
What Can the Radiologist Offer? RadioGraphics
2014; 34:764-776.
• Thelen J, Bhatt AA, Bhatt AA. Acute ocular
traumatic imaging: what the radiologist should
know. Emerg Radiol 2017; 24:585-592.

Contacts:
Matthew Lee MD
matthew.lee4@nyulangone.org
CT shows periorbital swelling, vitreous hemorrhage, retinal detachment,
Sergey Kochkine MD
In this example of globe rupture, and globe deformity, consistent with globe rupture. sergey.kochkine@nyulangone.org
the intraocular lens implant is The clinical photograph corresponding to this scan demonstrates scleral
extruded posteriorly (arrow). irregularity and hemorrhage.
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