Multimodal Imaging of Globe Compression Caused by a Displaced Orbital Fracture

A 52-year-old healthy man presented after a fall with direct blunt impact against a table edge. Head CT demonstrated a fracture of the right zygomatic process, with an inwardly displaced bony fragment impinging on the posterior globe wall (red arrow), without evidence of globe rupture or perforation (Panel A, left). Fundus examination revealed a focal superotemporal indentation of the posterior segment corresponding anatomically to the site of external compression (Panel B). B-scan ultrasonography demonstrated focal deformation of the globe contour with a posterior acoustic shadowing caused by the compressive bony fragment (Panel C). Optical coherence tomography through the corresponding region revealed focal indentation of the posterior globe wall (Panel D). Given the degree of globe compression, the patient underwent urgent orbital surgery via an extended eyelid crease approach. Four inwardly displaced orbital bone fragments were identified and removed, resulting in decompression of the globe. Postoperative CT obtained several hours after surgery demonstrated resolution of the bony impingement on the globe (Panel A, right). This case underscores the importance of a thorough dilated ocular examination following orbital trauma, as well as the need for dedicated orbital imaging. To our knowledge, optical coherence tomography documentation of posterior globe wall indentation from external bony compression has not been previously reported. Optical coherence tomography may provide additional value in evaluating the retina and choroid at the site of compression and may guide surgical urgency or prognosis.FIG.: