Phthisis bulbi - Clinical Tree

Key points

Definition: Phthisis bulbi (PB) is a generic descriptive term for the ocular globe’s “end-stage” appearance after wasting away, becoming anatomically disfigured, and shrunken as a result of a range of possible prior insults.
Also known as: end-stage eye, blind hypotensive eye, ocular phthisis, atrophia bulbi, atrophy eyeball, shrunken eyeball, phthisis eyeball, eyeball atrophy, and others.
Classic clue: Patient commonly presents with unilateral blindness related to old trauma and shows a small, shrunken globe with calcifications.
Pronounced “TIE-sis,” an ancient Greek medical term used to describe a disease where atrophy or wasting is a focal feature.

PB is often the end result of a major eye injury leaving a shrunken lump.
Addition of calcium deposits would make this a classic Aunt Minnie.
The globe is small and shrunken with diffuse linear or mottled calcium deposits (see Figure 8-1 ).
Scattered foci of calcium deposits and ossification in the sclera, cornea, lens, retina, and optic nerve (see Figure 8-1 ).
Fibrotic scarring may cause an irregular globe contour with diffusely increased attenuation (see Figure 8-1 ).
The globe is usually half to a third normal size as a result of reduced aqueous production (see Figure 8-1 ).
Devitalized tissue may demonstrate ossification.
The globe’s components are often distorted, and it may be difficult to identify separate structures, including the lens.
Vitreous humor enhancement may represent an early sign of inflammation.
Hypotonia causes thickened sclera and globe atrophy (see Figure 8-1 ).

Small, shrunken, deformed, calcified globe with enophthalmos.
T1 often isointense to normal eye with heterogeneous areas of increased signal, depending on degree of calcification and hemorrhage.
T2 often demonstrates dark signal of globe’s margin.
T2 shows heterogeneous vitreous containing dark “filling defects” caused by coarse calcifications.
Fluid-attenuated inversion recovery shows increased signal, which contrasts sharply with the dark contralateral globe.
Abnormal intraocular contents often appear deranged.
Vitreous cavity is heterogeneous and more hyperintense because of hemorrhage and/or fibrosis.
As the intraocular pressure decreases, the globe may assume a quadrilateral shape as a result of pressure from the extraocular muscles. This can be best appreciated on coronal imaging.
MRI may be contraindicated if a metallic intraocular foreign body (FB) is suggested. Intraocular FBs account for around 40% of penetrating ocular injuries.

Response to inflammation, infection, trauma, or severe ocular disease.
Has been reported in premature infants secondary to intrauterine methicillin-resistant Staphylococcus aureus .

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