 Introduction/Background Orbital disorders in children consist of varied pathologies affecting orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. Clinical manifestations of these disorders may range from ophthalmoplegia, decreased visual acuity, diplopia, nystagmus, exophthalmos/enophthalmos, papilledema, orbital soft tissue swelling, orbital pain, and, in most severe cases, monocular or binocular vision loss. The underlying etiology of these disorders may be traumatic or nontraumatic. Detailed clinical history along with a thorough clinical examination, including ophthalmologic and neurologic examination, is frequently able to localize the abnormality along the visual pathway. Presumed location of the lesion along with the additional findings like eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, and so on, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and /or head) [1]. Occasionally clinical signs and symptoms may be nonspecific, and, in these cases, diagnostic imaging studies play key role in depicting the nature and extent of the injury or disease [2]. Localization of the orbital abnormality on imaging is facilitated by a compartmental approach, which helps in the differential diagnosis based on the lesion location within the orbit (globe, extraconal, or intraconal space) or elsewhere in the visual pathway [3]. Traumatic injury in the setting of head injury or nonaccidental injury is discussed separately in ACR Appropriateness Criteria on these topics and is therefore excluded from this review. Special Imaging Considerations Ultrasound (US) is also an important diagnostic tool but is most often performed by the ophthalmologist or emergency physician and therefore not covered in this article.
Orbital Imaging and Vision Loss Child.  Introduction/Background Orbital disorders in children consist of varied pathologies affecting orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. Clinical manifestations of these disorders may range from ophthalmoplegia, decreased visual acuity, diplopia, nystagmus, exophthalmos/enophthalmos, papilledema, orbital soft tissue swelling, orbital pain, and, in most severe cases, monocular or binocular vision loss. The underlying etiology of these disorders may be traumatic or nontraumatic. Detailed clinical history along with a thorough clinical examination, including ophthalmologic and neurologic examination, is frequently able to localize the abnormality along the visual pathway. Presumed location of the lesion along with the additional findings like eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, and so on, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and /or head) [1]. Occasionally clinical signs and symptoms may be nonspecific, and, in these cases, diagnostic imaging studies play key role in depicting the nature and extent of the injury or disease [2]. Localization of the orbital abnormality on imaging is facilitated by a compartmental approach, which helps in the differential diagnosis based on the lesion location within the orbit (globe, extraconal, or intraconal space) or elsewhere in the visual pathway [3]. Traumatic injury in the setting of head injury or nonaccidental injury is discussed separately in ACR Appropriateness Criteria on these topics and is therefore excluded from this review. Special Imaging Considerations Ultrasound (US) is also an important diagnostic tool but is most often performed by the ophthalmologist or emergency physician and therefore not covered in this article.