Retinal Hemorrhages: Abusive Head Trauma or Not?

Document Type

Article

Publication Date

9-2018

Identifier

DOI: 10.1097/PEC.0000000000001605

Abstract

Abusive head trauma is an important cause of morbidity and mortality in infants and young children. Retinal hemorrhages (RHs) are frequently seen, particularly during dilated eye examination of these children. This review focuses on the evaluation of children with RH, with emphasis on the differential diagnosis, pathophysiology, and distinguishing features of RHs due to abusive head trauma. Many causes exist for RHs in infants and children. Most medical and accidental traumatic causes result in a pattern of RH that is nonspecific and not typical of the pattern and distribution of RHs seen in children with abusive head trauma. In children with intracranial hemorrhage and concerns for abuse, the finding of severe, multilayered RHs extending to the periphery of the retina is very specific for abuse as the cause of the findings, especially if retinoschisis is present. There are few other accidental traumatic mechanisms associated with retinoschisis, and the history of such a traumatic event is readily apparent. The indications for ophthalmologic consult, optimal timing of the eye examination, and significance of the findings are specifically discussed.

Journal Title

Pediatric emergency care

Volume

34

Issue

9

First Page

665

Last Page

670

MeSH Keywords

Child; Child Abuse; Craniocerebral Trauma; Diagnosis, Differential; Humans; Infant; Retinal Hemorrhage

Keywords

Child Abuse; Craniocerebral Trauma; Differential Diagnosis; Retinal Hemorrhage

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