After blunt trauma to the eye, a patient develops a peaked pupil pointing towards a clock position of 6 o'clock, hypotony (IOP 5 mmHg), and 360° conjunctival chemosis. There is no visible wound on slit-lamp examination. The next most appropriate investigation to confirm occult open globe injury is:
- A MRI orbit with gadolinium
- B B-scan ultrasonography
- C CT orbit (axial and coronal, thin cuts) ✓
- D X-ray orbit (Caldwell and Waters views)
Correct answer: C. CT orbit (axial and coronal, thin cuts)
Explanation
CT orbit (thin-cut axial and coronal views without contrast) is the investigation of choice for suspected open globe injury to detect: scleral discontinuity, intraocular foreign body, air in the vitreous (pneumophthalmia), or vitreous herniation. MRI is contraindicated if a ferromagnetic foreign body is possible. B-scan ultrasonography risks pressure on an open globe. Plain X-ray has poor sensitivity for soft-tissue injuries. CT also evaluates orbital wall fractures simultaneously.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.