1. Eviscerated Globe with Fat Graft
   Case: A 68-year-old male undergoing CT brain scan post evisceration of right eye phthisical eye with orbital fat grafting.

 (Fig. 1) CT -orbit showed well positioned right eye implant with anterior placement

Fat grafts are used post- evisceration to maintain orbital volume. Appears as a hypodense

non-enhancing region within the orbit.

2.    Intraocular Foreign Body (IOFB)
             Case: A 33-year-old male presented after industrial injury.

         CT brain shows hyperdense linear        

          object in the globe (Fig. 2)

                     CT is preferred for IOFB detection due to metal visibility.

3.   Scleral Buckle Artifact
             Case: A 56-year-old female with headaches underwent CT.

High-density structure seen encircling left                                                                     

    globe,  represents a silicone or metallic scleral buckle, often placed during retinal detachment repair(Fig. 3)

A scleral buckle is a common surgical treatment for retinal detachment, and it can produce distinct imaging artefacts on CT scans.

Band-like or C-shaped hyperdense structure around the posterior aspect of the eye              Often hyperdense (depending on the material — silicone, silicone sponge, or solid silicone)

May cause beam hardening or streak artefacts in CT images.

Sometimes can simulate foreign bodies or orbital masses if not recognized properly.

4. Artificial Eyeball Post Enucleation

        Case:  A 65 years male , diabetic and hypertensive on medications presented to emergency     

        department  with complaints of acute onset headache    & dizziness lasting for the past two days.     

         He also reported mild nausea , but denied any visual disturbances, weakness , sensory changes.                          NcCT brain was advised to rule out intracranial pathology such as hemorrhage.

                                                                                               (Fig. 4): Axial NCCT brain shows hyperdense round eye ball on left side indicated artificial eyeball post Enucleation.

         Prosthetic or artificial eyes appears as a round hyper-dense sphere. Sometimes it does not appear           

         round, but a concave eye attached to the orbital muscles. Now, a new trend of 3D printers can  

         make a prosthetic eye. In some cases, the patient is blind in both eyes and they undergo a

         bilateral oculoplasty.

5. Epidermal inclusion cyst

        Case: A 5-year-old male presented with with history of fall from bed in the morning with loss of   

        consciousness for 5 minutes. Ct brain was advised to look for fractures / intracranial bleed.

       (Fig. 5): CT of the orbit showed a well-defined, homogenous, hypodense mass located within the   

       subcutaneous tissue of the upper eyelid, with no signs of extension into the orbit or bone

       involvement. The imaging findings were consistent with an epidermal inclusion cyst.

6. Orbital schwannoma

        Case: A 40-year-old female presented with persistent headache localized to frontal region with     

        dizziness and occasionally loss of balance.  

(Fig. 6)CT revealed a well-circumscribed, ovoid mass in the intraconal space, causing displacement of the optic nerve. The lesion was heterogeneously hyperdense with intense enhancement following contrast administration. These findings were confirmed by MRI which was suggestive of an orbital schwannoma.

7. Orbital Cellulitis

        Case:  A 45-year-old male presented with history of fall from bike, CT brain was advised.          

CT imaging showed a blowout fracture of the left orbital floor with herniation of orbital

contents into the maxillary sinus. There was significant soft tissue swelling and gas bubbles in the retro-orbital space, indicative of secondary infection(Fig. 7)

8. Dislocated Lens

        Case: A 68 Year Old Male Presented To Emergency Department With Complaints Of Sudden  

        Onset Left Sided Headache And Blurring Of Vision In Left Eye

             CT scan shows left lens was deviated posteriorly into vitreous cavity(Fig. 8)

DISLOCATED LENS or ectopia lentis occurs due to trauma, Weil-Marchesani syndrome, Ehlers-Danlos syndrome, homocystinuria, aniridia, syphilis, intraocular tumors, and Marfan syndrome.

9. Phthisis Bulbi

        Case: 62 year old female patient presented to the emergency department with complaints of   

        persistent headache and intermittent visual disturbances in her left eye.She is hypertensive and    

        diabetic with no history of ocular trauma.

Small and shrunken globe with calcification  with with irregular contour  with loss of the ability to identify separate structures s/o phthisis bulbi. (Fig. 9)

       PHTHISIS BULBI is the end stage or atrophied eye ball due to a severe insult. The eye ball usually     

       is reduced in size by 20 mm with posterior folded sclera. This intraocular fibrosis and shrinkage  

       lead to an intraocular hypotension.Dystrophic calcification is seen in some cases which known as

       intraocular bones. Having calcification in the eye should not be confused with phthisis bulbi  

       because calcification of the eye could happen for different reasons. The calcification could reach the

       globe, sclera, optic nerve, etc.The etiology of phthisis bulbi includes the following; infection,    

       inflammation, trauma,retinoblastoma, chronic retinal detachment, persistent hyperplastic primary

       vitreous, etc.

10. Cataract

          Case: 60 year old male with h/o fall from height.

                     Dense right lens(Fig. 10).

      CATARACTS are an opacification or thickening of the lens within the globe and are the leading         

      cause of blindness in the world. 

      CT is not the investigation of choice for the lens as radiation may worsen lens opacification. 

      Imaging findings in cataract – increased density and thickness of lens, in diabetic cataract if there is    

      osmotic swelling the lens may appear hypodense than surrounding structures.                                            

     CT scan can reveal changes in lens density that correlate with different types of cataracts reveals    

     nuclear cataract shows a hyperdense central region , cortical cataract presents as a wedge shaped   

     opacity and posterior subcapsular cataract appears as a small dense area beneath the capsule.

Ophthalmological findings on routine brain imaging, though uncommon, can be diagnostically significant. These cases reinforce the importance of routinely evaluating the orbital contents in CTscan neuroimaging. Attention to the orbits can prevent missed diagnoses, influence clinical management, and guide necessary ophthalmologic referrals.

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6. Ophthalmology Findings on Brain Scans: A Pictorial Essay Abdulwahab F. Alahmari