Pediatric Radiology

, Volume 44, Supplement 4, pp 571–577 | Cite as

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

  • Gil Binenbaum
  • Brian J. Forbes
Special Issue: Abusive Head Trauma


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.


Retinal hemorrhage Abusive head trauma Child abuse Ocular injury Shaken baby syndrome 


Conflicts of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.The Children’s Hospital of PhiladelphiaThe Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Pediatric Ophthalmology, 9-MAINThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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