Diagnostic and Predictive Value of Multidetector Computed Tomography in Craniofacial Trauma Patients to Detect Incidental and Clinically Unassessable Causes of Visual Impairment

Background: Craniofacial trauma is a public health issue of pivotal relevance with a high frequency and number of access-es to the Emergency Departments and can cause damage to the eye and orbit, resulting in significant impairment if not timely diagnosed and properly managed. Early ophthalmologic examination is mandatory for appro-priate management of ocular injuries. In the setting of acute trauma, clinical examination is often limited by peri-orbital soft tissue swelling or damage, severe pain and patient’s gener-al condition. Therefore, the role of imaging is most important in such situations for evaluation of injuries to brain, skull, facial bones and thequick and three-dimensional evaluation of the or-bital cavity. Because CT imaging is widely used in the initial evaluation of patients with head and facial trauma, radiologists will often interpret CT examinations before detailed ophthalmologic eval-uation has been done. Aim of Study: Was to show the role of CT in assessing or-bital injuries where neuro-ophthalmologic exploration is limit-ed such as in hyphema, traumatic cataract or uncooperative pa-tients like comatosed ones and its ability to detect early causes of visual impairment. We also suggested the possibility of trau-matic optic neuropathy (TON) on the basis of CT findings and determined the specific CT findings that can be used to predict TON in patients with craniofacial trauma. Patients and Methods: We included 42 patients (34 males and eight females) who suffered from life-threatening trauma and received a polytrauma CT scan between April 2022 and October 2022 at the Emergency Department of Kasr Al-Ainy hospital. All patients had eye injuries with hindered ocular ex-amination either due to local obscuring injury or consciousness affection preventing proper clinical evaluation and were re-ferred to the Diagnostic Radiology Department at Kasr Al-Ainy Hospital for CT evaluation. Results: Blunt trauma was the most common type of trau-ma and was seen in 26 patients (61.9%) while penetrating trauma was seen in 16 patients (38.1%).Non cooperative status was the most common cause that limited proper clinical ex-amination. Association between type of trauma (blunt or pene-trating) with type of injuries found on CT, showed statistically significant association between orbital wall fractures and blunt trauma (p-value <0.001) and between open globe injuries and penetrating trauma (p-value <0.001). Conclusion: The results of our study speak in favor for combined early ophthalmological consultations and radiolog-ical imaging. Diagnostic and treatment of possible orbital inju-ries should be remembered in a polytrauma patient.