E1303. Don’t Poke Your Eyes Out: Distinguishing Normal Post-Treatment Orbit and Pathologic Findings
  1. Cameron Overfield; Mayo Clinic - Jacksonville
  2. Alok Bhatt; Mayo Clinic - Jacksonville
The orbits are imaged incidentally on many examinations and are also prone to a wide array of pathology. The sequelae of numerous surgical procedures involving the orbit can potentially mimic pathologic entities such as unintentional foreign bodies. As a result, knowledge of both pathology and normal appearance of intraorbital devices and post-treatment changes is important.

Educational Goals / Teaching Points
After review of this presentation the audience will be able to recognize the expected normal imaging appearance of the posttreatment orbit with emphasize on implants commonly seen in practice. The imaging appearances of orbital devices will be compared with pathologic mimics using a case-based approach.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Evaluation of the posttreatment orbit is easy if divided into compartments. The classification system in this presentation is as follows: inside the globe, around the globe, outside the globe, or without globe (post enucleation). Lens replacement and intraocular injection are located within the globe. Intraocular injections of silicone for retinal detachment can mimic intraocular hemorrhage. Devices located around the globe such as scleral buckle and numerous glaucoma devices are common. Pathologic scleral plaques can be confused with scleral buckles. Glaucoma devices have varied imaging manifestations and similarities with unintentional foreign bodies. Pathologies outside the globe such as thyroid orbitopathy can be mistaken for ocular rectus muscle injection for strabismus. Punctal plugs are confused with orbital calcifications and eyelid weights with foreign bodies. Scans with flap reconstruction post enucleation (without globe) must be interrogated extensively to separate recurrent disease from the normal posttreatment appearance.

The posttreatment orbit can be a challenging exam to interpret, as normal posttreatment findings can be potentially misdiagnosed as pathology. Knowledge of different orbital devices, placement techniques, and pathologic mimics are therefore essential for interpretation of exams.