Is pre-operative computed tomography mandatory in the workup of open globe injuries?

PURPOSE: To evaluate the necessity of computed tomography (CT) in open globe injuries after ophthalmological assessment in the emergency department (ED) prior to primary repair. METHODS: A review of the medical records of patients diagnosed with open globe injuries over a 1-year period (2023-2024) was conducted. Main outcome measures were clinically relevant CT findings. Demographics and clinical characteristics of trauma were also analyzed. RESULTS: 166 eyes were included. Mean age was 25 ± 16.9 years and logMAR vision 1.99 ± 0.678. 60.2% had penetrating and 5.4% perforating injuries. 60.2% of eyes had zone I injuries. OTS raw score was 50.6 ± 10.7. 34.3% of injuries were caused by metal objects and 9% were secondary to firearm injuries. 38 eyes had evidence of IOFB on pre-operative CT scan, 18 of which were metal fragments and 9 were gunshot injuries. The nature of object and type of injury were associated with IOFB presence (p<0.001 and 0.02). Iris, AC, lens and vitreous findings were all associated with the presence of IOFB (p=0.02, <0.001, 0.005 and 0.049). Intraoperatively, FBs were clinically detectable and surgically removed during primary repair in 10 patients with IOFB. In the remaining 28 eyes primary repair was performed and FB was removed after 2 weeks via pars plana vitrectomy. US done following primary repair detected 5 eyes with IOFB which had pre-operative normal CT scans. CT findings did not alter plan for initial surgical intervention in any case. CONCLUSION: CT scan is an invaluable tool in the ED but not mandatory pre-operatively in all cases of open globe injuries following clinical examination.