Introduction: Open globe injury is a surgical emergency requiring prompt diagnosis to minimize morbidity. Orbital CT is frequently performed in trauma settings and is crucial for globe evaluation, particularly when bedside assessment is limited. The primary objective was to evaluate the diagnostic accuracy of overall CT impression for detecting open globe injury. The secondary objective was to assess the diagnostic accuracy of CT imaging signs.
Methods: A systematic review protocol was prospectively registered (PROSPERO CRD42025638703). On January 16, 2025, Embase, Pubmed, Scopus, and Google Scholar were searched without date restrictions. Diagnostic accuracy meta-analyses were performed on overall CT impression and individual CT imaging signs for open globe injury. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
Results: Eight studies met inclusion criteria representing 827 patients, 830 injured globes, and 339 confirmed open globe injury. The pooled sensitivity and specificity of overall CT impression was 75% (95% CI, 0.69-0.79) and 94% (95% CI, 0.91-0.96), respectively. Among individual signs, change in globe contour or scleral irregularity had the highest diagnostic odds ratio (109; 95% CI, 17-718) with sensitivity and specificity of 71% (95% CI, 0.61-0.79) and 98% (95% CI, 0.86-1.00), respectively. Change in anterior chamber depth, vitreous hemorrhage, lens abnormality, and intraocular air were insensitive but highly specific signs.
Conclusions: Overall CT impression and individual imaging signs demonstrate high specificity but limited sensitivity for open globe injury. Surgical exploration remains necessary when clinical suspicion persists despite inconclusive imaging.
Keywords: CT; Computed tomography; Diagnostic accuracy; Globe rupture; Meta-analysis; Ocular trauma; Open globe injury; Systematic review.
Copyright © 2026. Published by Elsevier Ltd.