Ocular Manifestations of Child Abuse

Elner, Victor M.

doi:10.1001/archopht.126.8.1141

Cited by 16 publications

(3 citation statements)

References 27 publications

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“… 11 – 14 The rate of RH in confirmed abuse cases in various studies ranges from 50% to 100%, and severity of RH tends to correlate well with severity of brain injury and mortality rate. 5 , 9 , 15 …”

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confidence: 99%

Risk factors associated with retinal hemorrhage in suspected abusive head trauma

Burkhart

Thurber²,

Chuang³

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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PurposeTo determine risk factors associated with retinal hemorrhage (RH) in pediatric abusive head trauma (AHT) suspects.MethodsRecords of children aged 0–3 years hospitalized for suspected AHT from January 2007 to November 2011 were retrospectively reviewed in this case–control study. Children were classified into case and control groups based on RH presence. Medical history, presenting symptoms, reasons, and characteristics of injury were recorded. Logistic regression analysis was performed to identify risk factors.ResultsA total of 168 children (104 males) were included. Of these, 103 were classified as cases and 65 as controls. The mean age (with standard deviation) was 9.3 ± 8.3 months (range, 1 day-36 months). Of the 103 cases, 22 (21%) had subretinal hemorrhage, 9 (9%) had retinoschisis, and 1 (1%) had vitreous hemorrhage. Children presenting with lethargy or altered mental status (P < 0.0001), subdural hemorrhage (P < 0.0001), and other radiologic findings (eg, cerebral ischemia, diffuse axonal injury, hydrocephalus, or solid organ injury; P = 0.01546) were likely to have RH. All 23 children with skull or nonskull fracture without intracranial hemorrhage did not have RH (P < 0.0001 both categories).ConclusionsRetinal hemorrhages were almost never found in the absence of intracranial hemorrhage and not found in the setting of fracture without intracranial hemorrhage.

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confidence: 99%

Risk factors associated with retinal hemorrhage in suspected abusive head trauma

Burkhart

Thurber²,

Chuang³

et al. 2015

Journal of American Association for Pediatric Ophthalmology and

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“…These injuries cause significant morbidity and mortality in infants with an incidence of 17 per 100,000 person-years [90]. The injuries result in mortality in as many as 30% of victims, and survivors are left with severe cognitive, motor, visual, and behavioural disabilities [91]. Vitreous, subhyaloid, intraretinal, and subretinal haemorrhages; macular folds, and retinoschisis are cardinal ophthalmic signs of AHT [92], with periocular ecchymosis and edema observed in 15% cases [93].…”

Section: Traumatic Periocular Ecchymosismentioning

confidence: 99%

Spontaneous Periocular Ecchymosis in Children: Differential Diagnosis and Current Trends in Evaluation and Management

Kavoussi¹,

Pasco²,

Mears³

et al. 2014

J Clin Exp Ophthalmol

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While periocular ecchymosis commonly develops following surgery or traumatic injury to the orbit, the spontaneous appearance of periocular ecchymosis in children can indicate the presence of life-threatening conditions including pediatric malignancies (neuroblastoma, rhabdomyosarcoma, leukemia) and hematologic disorders (aplastic anemia, thrombocytopenia). Vascular malformations (capillary hemangioma, lymphangioma, orbital varix), inflammatory conditions (orbital myositis, amyloidosis), pertussis, and Blue rubber bleb nevus syndrome are benign differential considerations with visual complications in certain instances. Since spontaneous periocular ecchymosis (SPE) can be encountered by pediatric subspecialists both within and outside ophthalmology, the authors present a review of the current literature integrating the clinical features, latest diagnostic investigations, and updates in management for the entities that cause spontaneous periocular ecchymosis in children. A comprehensive and current understanding of the differential diagnosis elicited by this unique ocular finding will aid the clinician in managing long-term visual consequences and coordinating with appropriate pediatric subspecialists.

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“…This can be the result of violent acceleration–deceleration forces such as those generated through forceful shaking. Such shaking is also thought to produce traction forces in the eye that can tear retinal vessels with resulting retinal hemorrhages (61). Subdural hematoma in combination with retinal hemorrhages and encephalopathy forms a triad that has long been held to strongly indicate the possibility of an inflicted traumatic brain injury – the ‘shaken baby syndrome’ (62).…”

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confidence: 99%

Safeguarding children: why an issue for pediatric anesthetists?

Deloughry

Wilkinson

2009

Pediatric Anesthesia

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Child maltreatment and the responsibility of heath care professionals to assist in prevention and diagnosis is currently center stage in the United Kingdom. This subject has a very large literature base. Anesthetists were one of the first groups to have specific guidance on this subject, and key competencies are now part of the core curriculum for our trainees. This article seeks to briefly define maltreatment and provide statistics that outline the scale of the problem, and includes discussion of risk factors and recognition. We have focused on physical abuse and have provided a separate section on abusive head trauma, which is of particular importance to anesthetists. We also discuss the process of management, with some detail around Child Death Review procedures.

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Ocular Manifestations of Child Abuse

Cited by 16 publications

References 27 publications

Risk factors associated with retinal hemorrhage in suspected abusive head trauma

Risk factors associated with retinal hemorrhage in suspected abusive head trauma

Spontaneous Periocular Ecchymosis in Children: Differential Diagnosis and Current Trends in Evaluation and Management

Safeguarding children: why an issue for pediatric anesthetists?

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