Orbital Pathology (Suspected)
Pathway Home
Population Covered By The Guidance
This pathway provides guidance on imaging patients with traumatic and non-traumatic orbital pathology.
Date reviewed: July 2014
Date of next review: December 2023
Published: July 2014
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Images
Image GalleryNote: These images open in a new page |
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| 1 |  |
Inferior Orbital Margin Fracture with Trapping of Inferior Rectus Muscle Image 1 - Computed Tomography Coronal image demonstrating a traumatic fracture of the inferior orbital margin with soft tissue (arrowhead) and inferior rectus muscle (arrow) extending into fracture. |
| 2a |  |
Uveal Melanoma Image 2a and 2b - Magnetic Resonance Imaging T1 and T2-weighted images showing melanoma of the left uvea (arrow). |
| 2b |  |
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| 3a |  |
Uveal Melanoma Image 3a - Gross pathology Orbital enucleation showing a uveal malignant melanoma (blue arrow) arising posteriorly and causing retinal detachment (white arrow). |
| 3b |  |
Image 3b (H&E, x2.5) and 3c (H&E, x20) - Histopathology Uveal malignant melanoma infiltrating beneath the retinal layer (blue arrow) and showing marked nuclear atypia with cytoplasmic and extracellular melanin pigment production. |
| 3c | |
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Teaching Points
Teaching Points
- Plain films have a limited role in the assessment of orbital trauma
- If an orbital pathology is suspected clinically, CT is the imaging modality of choice. It enables superior visualisation of the bone structures of the midface and orbits
- MRI is a useful adjunt to CT, particularly in identifying soft tissue injury. Before a patient undergoes MRI, foreign metal in the orbit should first be excluded (on plain films or CT)
- In the assessment of traumatic orbital pathology CT is the modality of choice. For non-traumatic orbital pathology, MRI is the preferred imaging modality provided it is available and there are no contraindications
References
References
Date of literature search: June 2014
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Go JL, Vu VN, Lee KJ, et al. Orbital trauma. Neuroimaging Clin N Am. 2002;12(2):311-24. (Review article). View the reference
- Belden CJ, Zinreich SJ. Orbital imaging techniques. Semin Ultrasound CT MRI. 1997;18(6):413-22. (Review article). View the reference
- Brady SM, McMann MA, Mazzoli RA, et al. The diagnosis and management of orbital blowout fractures: update 2001. Am J Emerg Med. 2001;19:147-54. (Level IV evidence). View the reference
- Lakits A, Prokesch R, Scholda C, et al. Orbital helical computed tomography in the diagnosis and management of eye trauma. Ophthalmology. 1999;106:2330-5. (Level II/III evidence). View the reference
- Gor DM, Kirsch CF, Leen J, et al. Radiologic differentiation of intraocular glass: evaluation of imaging techniques, glass types, size, and effect of intraocular haemorrhage. AJR Am J Roentgenol. 2001;177:1199-203. (Level II/III evidence). View the reference
- Maya MM, Heier LA. Orbital CT: current use in the MR era. Neuroimaging Clin N Am. 1998;8(3):651-93. (Review article). View the reference
- Ettl A, Kramer J, Daxer A, et al. High resolution magnetic resonance imaging of neurovascular orbital anatomy. Ophthalmology. 1997;104:869-77. (Level III evidence). View the reference
- Tonami H, Tamamura H, Kimizu K, et al. Intraocular lesions in patients with systemic disease: findings on MR imaging. AJR Am J Roentgenol. 1990;154(2):385-9. (Level III evidence). View the reference
- Breslau J, Dalley RW, Tsuruda JS, et al. Phased-array surface coil MR of the orbits and optic nerves. AJNR Am J Neuroradiol. 1995;16:1247-51. (Level III evidence). View the reference
- Peyster RG, Augsburger JJ, Shields JA, et al. Intraocular tumors: evaluation with MR imaging. Radiology. 1988;168(3):773-9. (Level IV evidence). View the reference
- Gomori JM, Grossman RI, Shields JA, et al. Choroidal melanomas: correlation of NMR spectroscopy and MR imaging. Radiology. 1986;158:443-5. (Level III evidence). View the reference
- Gass A, Barker GJ, MacManus D, et al. High resolution magnetic resonance imaging of the anterior visual pathway in patients with optic neuropathies using fast spin echo and phased array local coils. J Neurol Neurosurg Psychiatry. 1995;58:562-9. (Level III evidence). View the reference
- Dunker S, Wiegand W. Prognostic value of magnetic resonance imaging in monosymptomatic optic neuritis. Ophthalmology. 1996;103:1768-73. (Level III evidence). View the reference
- Mosley IF. The plain radiograph in ophthalmology: a wasteful and potentially dangerous anachronism. J Royal Soc Med. 1991;84:76-80. (Level II evidence). View the reference
- Bhattacharya J, Mosley IF, Fells P. The role of plain radiography in the management of suspected orbital blow-out fractures. Br J Radiol. 1997;70:29-33. (Level III evidence). View the reference
- Otto PM, Otto RA, Virapongse C, et al. Screening test for detection of metallic foreign objects in the orbit before magnetic resonance imaging. Invest Radiol. 1992;27:308-11. (Level III evidence). View the reference
Further Reading
- Duvoisin B, Zanella FE, Sievers KW. Imaging of the normal and pathological orbit. Eur Radiol. 1998;8:175-188. View the reference
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Contrast Medium (Gadolinium versus Iodine) Iodine-Containing Contrast Medium Magnetic Resonance Imaging (MRI) Radiation Risk of Medical Imaging During Pregnancy |
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