The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Orbital Imaging and Vision Loss-Child Discussion of Procedures by Variant Variant 1: Child. Traumatic visual loss. Suspected orbital injury. Initial imaging. Traumatic injury is the leading cause of noncongenital monocular vision loss in children [4]. Common signs of orbital injuries include periorbital soft tissue swelling, ecchymosis, hyphemia, subconjunctival hemorrhage, diplopia, restriction of ocular movement, or vision loss. The most common causes of pediatric orbital fractures are motor vehicle collision, sports injury, falls, and assault [5]. Data from combined pediatric and adult series show that ocular injuries account for approximately 3% of all visits to the emergency department [6]. Orbital fractures account for 3% to 45% of all pediatric facial fractures [5]. Orbital roof fractures are the most common orbital fractures in children <8 years of age, and orbital floor fractures are most common in older children [7]. Serious ocular injuries in conjunction with orbital fracture are less common in children compared with adults. In one series, serious ocular injury was reported in approximately 20% of children with orbital fractures [7]. Traumatic brain injuries are more commonly associated with orbital fractures in younger children because orbital roof fractures are more common in this age group [7]. Elastic, cancellous bone with resilient periosteum in children leads to trap door orbital fracture, which in turn causes entrapment of the extraocular muscles or other orbital contents [8], leading to restriction of ocular movement and diplopia.
Orbital Imaging and Vision Loss Child. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Orbital Imaging and Vision Loss-Child Discussion of Procedures by Variant Variant 1: Child. Traumatic visual loss. Suspected orbital injury. Initial imaging. Traumatic injury is the leading cause of noncongenital monocular vision loss in children [4]. Common signs of orbital injuries include periorbital soft tissue swelling, ecchymosis, hyphemia, subconjunctival hemorrhage, diplopia, restriction of ocular movement, or vision loss. The most common causes of pediatric orbital fractures are motor vehicle collision, sports injury, falls, and assault [5]. Data from combined pediatric and adult series show that ocular injuries account for approximately 3% of all visits to the emergency department [6]. Orbital fractures account for 3% to 45% of all pediatric facial fractures [5]. Orbital roof fractures are the most common orbital fractures in children <8 years of age, and orbital floor fractures are most common in older children [7]. Serious ocular injuries in conjunction with orbital fracture are less common in children compared with adults. In one series, serious ocular injury was reported in approximately 20% of children with orbital fractures [7]. Traumatic brain injuries are more commonly associated with orbital fractures in younger children because orbital roof fractures are more common in this age group [7]. Elastic, cancellous bone with resilient periosteum in children leads to trap door orbital fracture, which in turn causes entrapment of the extraocular muscles or other orbital contents [8], leading to restriction of ocular movement and diplopia.