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Background
Panophthalmitis is the most severe form of endophthalmitis, caused by an acute suppurative infection of the globe and orbital soft tissue, with involvement of the extraocular structures of the orbit. It is rare, with an estimated incidence rate of five per 10,000. It is known to develop rapidly and require enucleation or evisceration; however, early treatment with antibiotic and dexamethasone combinations have been shown to result in improved outcomes and even resolution of panophthalmitis. Unfortunately, misdiagnosis remains a common occurrence, often stemming from variability in clinical presentation. Current diagnostic methods are via intraocular vitreous or aqueous sampling, which carry attendant risks and have suboptimal sensitivity despite adequate sampling. Therefore, a good understanding of the orbital anatomy and imaging findings for orbital infections will facilitate prompt identification and initiation of treatment. This can, in turn, prevent devastating complications and permanent vision loss, and aid in staging disease extent.

Educational Goals / Teaching Points
At the end of reviewing the exhibit, the reader should be able to Identify the different layers of the globe on MRI, recognize ocular membrane detachment and the three potential spaces for which exudates and abscesses may collect, understand the pathophysiology behind endogenous endophthalmitis and how the different layers of the globe, as well as extraocular structures, could be potentially affected, recognize the spectrum of imaging findings in panopthalmitis, ranging from mild to advanced disease, including frank orbital cellulitis, and recognize the importance of DWI/ADC and FLAIR in identifying purulent exudates.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will illustrate a case-based pictorial review of imaging features of panophthalmitis on MRI. Specific attention will be made to highlight the different anatomic components of the orbit, with special attention to the globe and its layers as well as the extraocular soft tissues. These include clearly annotated images depicting early changes ranging from thickening and enhancement of the uveoscleral layer to advanced disease including ocular membrane detachment, collection of exudates and abscesses in the vitreous chamber, and potential spaces such as the subhyaloid space, subretinal space or suprachoroidal space, and frank orbital cellulitis.

Conclusion
Panophthalmitis is a severe orbital infection that can result in devastating visual compromise. Recognizing the imaging characteristics and identifying the anatomic structures involved will allow for early implementation of appropriate investigations and treatment to salvage patients’ orbit and vision.