The role of computerised tomography in predicting visual outcome in ocular trauma patients.

Purpose: Ocular blast injuries in the military setting are particularly associated with significant maxillofacial trauma and/or brain injury. The opportunity to perform a comprehensive ophthalmic evaluation is frequently limited in the acute multiple trauma scenario. We aim to describe the relationship between the clinical effects of acute ocular and orbital blast trauma with the findings on computerised tomography (CT).

Methods: This was a retrospective consecutive case series of all soldiers with facial and/or suspected ocular injuries. A total of 80 eyes that had suffered blast injuries of varying severity were studied. Assessment of orbital and ocular CT images were performed by military consultant radiologists. A comparison was made with actual clinical findings. Statistical analysis was performed using Fisher's exact test.

Results: No pathological findings were described in 37 of the 80 eyes imaged by orbital and ocular CT scans. Clinically, these eyes and orbits were all found to be intact, or had minor trauma. All foreign bodies and penetrating eye injuries were successfully diagnosed by CT. Absence of an orbital fracture did not rule out a globe injury. However, a corneal or scleral defect was less likely when an orbital fracture was absent.

Conclusion: The eye is a delicate structure prone to injury that requires urgent repair if breached. It is difficult to assess thoroughly in the unconscious or distressed patient. In this context, CT imaging is invaluable to be able to make a relatively confident prediction of clinical findings and decide upon the necessity for acute ophthalmic surgical intervention.