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The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma

  • Special Issue: Abusive Head Trauma
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

This review presents an up-to-date overview of ocular injuries resulting from child abuse, with a spotlight on abusive head trauma. Retinal hemorrhage is a principle finding of inflicted head trauma. The specific pattern of hemorrhages holds valuable diagnostic information, which can help to guide multidisciplinary assessments of the likelihood of abuse. Indirect ophthalmoscopy through dilated pupils by an ophthalmologist is necessary for adequate examination and documentation of retinal findings. Initial pediatrician evaluation of the eye and indications for ophthalmological consultation are reviewed. Focus is then placed upon understanding retinal hemorrhage patterns, their diagnostic significance and likely pathophysiological mechanisms. The differential diagnosis of retinal hemorrhage in young children is discussed, highlighting key distinctions among retinal hemorrhage patterns, severity and frequencies, as well as other ocular findings. The most common cause of retinal hemorrhage in an infant is trauma, and most other causes can be identified by considering the hemorrhage pattern, ocular or systemic signs and the results of laboratory and imaging tests, when indicated.

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Authors and Affiliations

  1. The Children’s Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Gil Binenbaum & Brian J. Forbes

  2. Pediatric Ophthalmology, 9-MAIN, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Gil Binenbaum & Brian J. Forbes

Authors
  1. Gil Binenbaum
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  2. Brian J. Forbes
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Correspondence to Gil Binenbaum.

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Binenbaum, G., Forbes, B.J. The eye in child abuse: Key points on retinal hemorrhages and abusive head trauma. Pediatr Radiol 44 (Suppl 4), 571–577 (2014). https://doi.org/10.1007/s00247-014-3107-9

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  • DOI: https://doi.org/10.1007/s00247-014-3107-9

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