Imaging recommendation · Neuro · Head & Neck

Acute proptosis or vision loss after facial trauma

Q: What's the alternative imaging for acute proptosis or vision loss after facial trauma when globe rupture suspected?

CT — CT Orbits non-contrast (avoid pressure-applying maneuvers) (no contrast).

Recommended: CT Orbits without contrast (emergent) is the preferred imaging study for acute proptosis or vision loss after facial trauma. Retrobulbar hematoma is a vision-threatening emergency — surgical decompression within minutes.

Recommended study

CT Orbits without contrast (emergent)

CT No contrast Preferred Neuro · Head & Neck Emergency Reviewed 2026-05

Retrobulbar hematoma is a vision-threatening emergency — surgical decompression within minutes.

If the default doesn't apply

Globe rupture suspected

CT CT Orbits non-contrast (avoid pressure-applying maneuvers) No contrast

Watch-outs

Decreased visual acuity + proptosis + tense globe

Perform lateral canthotomy + cantholysis at the bedside — do not delay for imaging.

Increased IOP > 40 mmHg

Orbital compartment syndrome; urgent decompression preserves vision.

Pearls

Vision-threatening — time to decompression matters more than imaging precision.
Look for associated globe injury (deformity, hyphema, vitreous hemorrhage) on CT.
Apex hematoma may compress optic nerve without overt proptosis.