Imaging in Ocular & Orbital Trauma
Christian J. Thompson, OD, FAAO
Chinle Hospital, IHS, DHHS
Chinle, AZ 86503
christian.thompson@ihs.gov
Valerie Sharpe, OD, FAAO
Alpine Eyecare
Telluride, CO 81435
valerie.sharpe@ihs.gov
ABSTRACT
This lecture focuses on the imaging of ocular and orbital injuries, with an emphasis on
computed tomography (CT scan) as the modality of choice. It includes the most common
scenarios in which optometrists participate in the management of trauma victims. The
basics of ordering and interpreting CT scans in the setting of trauma are addressed.
LEARNING OBJECTIVES
1. To review the basic bony anatomy of the orbit, face and surrounding structures
2. To enhance awareness of the terminology related to imaging in ocular & orbital trauma
3. To become familiar with the pertinent decisions inherent to trauma management
4. To highlight the importance of appropriate communication with other disciplines
5. To encourage optometrists to participate in the care of victims of facial trauma
OUTLINE
I. Introduction
A. Imaging for ocular & orbital trauma
1. Why do optometrists need a working knowledge of CT scan imaging?
a) Many ocular & orbital diseases require imaging for appropriate management
b) Ocular injuries often mandate imaging to rule out orbital injuries
c) Imaging results & interpretation can help facilitate the best management plan
2. Why do optometrists need to participate in the care of trauma victims?
a) The eyes are located in the middle of the face
b) Ocular & orbital injuries are common in the setting of facial & head trauma
c) Access to eye care specialists in the ED setting is often limited
B. CASE#1:
1. Optometric exam
a) History
b) Entrance exam
c) Slit lamp exam
d) Diagnosis
e) Management
2. Imaging study
a) CT scan ordering
b) CT scan interpretation
II. Imaging Basics
A. X-Ray
1. Basic radiography (tips for interpretation of an X-ray)
2. Clinical applications for the optometrist
a) Foreign body localization
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Imaging in Ocular & Orbital Trauma
b) Other systemic conditions
B. CT Scan
1. Basic computed tomography
a) With or without contrast?
b) Radiation
c) Tips for interpretation of a CT scan
2. Clinical applications relevant to the optometrist
a) Head trauma
b) Headache & visual field/neurologic defects?
c) Ocular, orbital & facial trauma
d) Proptosis (tumor, cellulitis, orbitopathy)
e) Sinusitis
f) Stroke
3. Basic bony anatomy of the orbit & surrounding structures
a) Orbit
b) Facial bones & sinuses
c) Cranium
III. CT Scans for Ocular Trauma
A. CASE#2: Open Globe Injury
1. Optometric Exam
a) History
a) Ocular examination
b) Diagnosis
c) Management
2. Imaging Study
a) CT Scan ordering
b) CT Scan interpretation
B. CASE#3: Closed Globe Injury
1. Optometric Exam
b) History
a) Ocular examination
b) Diagnosis
c) Management
2. Imaging Study
a) CT Scan ordering
b) CT Scan interpretation
IV. CT Scans for Orbital & Facial Trauma
A. CASE#4: Orbital Trauma
1. Optometric Exam
c) History
a) Ocular examination
b) Diagnosis
c) Management
2. Imaging Study
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Imaging in Ocular & Orbital Trauma
a) CT Scan ordering
b) CT Scan interpretation
B. CASE#5: Facial Trauma
1. Optometric Exam
d) History
a) Ocular examination
b) Diagnosis
c) Management
2. Imaging Study
a) CT Scan ordering
b) CT Scan interpretation
V. Conclusions: Getting involved
A. Optometrists need to know when and how to order imaging for trauma
1. Work with physicians from other disciplines
a) Develop good relationships
b) Maintain good communication, always send consultation letters
c) These services benefit the patient, our profession & your “bottom-line”
d) Market your expertise beyond refractive eye-care
2. Don’t be afraid to advocate for your patients
a) Trauma patients frequently have inadequate access to good follow-up care
b) Specialists don’t always recognize the big picture
B. Seek opportunities to examine more trauma patients
1. On-Call “The OD in the ED”
a) Hospital based setting
b) Develop relationships with local ED providers
c) Get credentialed at local hospital, provide on-call services
d) Be available to ED/urgent care providers for phone consultations and f/u appt
2. Under-served population for ocular trauma patients
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