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Computed tomography (CT) and magnetic resonance imaging (MRI) are powerful adjuncts in the diagnosis of retrobulbar lesions, but the cost of these studies (now often over $1000 each) has imposed two major imperatives on ophthalmologists and all other physicians: order imaging studies only if the expected yield is reasonably high, and maximize the study's yield by providing clinical guidelines so that the study may be tailored to the expected lesion.
Retrobulbar imaging studies should be ordered only when there is a strong suspicion of finding a gross alteration of orbital or intracranial structures. The most common settings for low-yield imaging studies in ophthalmology are periocular pain and unexplained visual loss, that is, subnormal visual acuity or visual field that cannot be readily attributed to abnormalities of the eyeball. The yield of such studies in cases of periocular pain without contributory physical findings is minuscule. As for unexplained visual loss, the
Trobe JD, Gebarski SS. Looking Behind the Eyes: The Proper Use of Modern Imaging. Arch Ophthalmol. 1993;111(9):1185–1186. doi:10.1001/archopht.1993.01090090037016
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