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Isolated subconjunctival hemorrhages in nonaccidental trauma
Stephen G Spitzer1, Joseph Luorno, Léon-Paul Noël
1Department of Ophthalmology, Upstate Medical University, Syracuse, New York, USA.
Summary
Child abuse should be considered in infants with unexplained bilateral subconjunctival hemorrhages. These eye injuries may indicate nonaccidental trauma, requiring thorough medical evaluation.
Area of Science:
- Pediatric Ophthalmology
- Child Abuse Detection
- Forensic Medicine
Background:
- Subconjunctival hemorrhages in infants can be challenging to diagnose.
- Distinguishing accidental from nonaccidental trauma is crucial for infant safety.
Observation:
- Three cases of infants presenting with isolated bilateral subconjunctival hemorrhages are reviewed.
- Initial findings were normal except for the eye hemorrhages; some later revealed fractures or signs of abuse.
Findings:
- Bilateral subconjunctival hemorrhages, especially with facial petechiae, can be indicative of nonaccidental trauma.
- These hemorrhages may be linked to traumatic asphyxia syndrome from chest compression.
- Normal initial labs and imaging do not rule out abuse; repeat studies may be necessary.
Implications:
- Ophthalmologists and pediatricians must include child abuse in the differential diagnosis for these presentations.
- Comprehensive ophthalmic, pediatric, hematological, and imaging assessments are vital.
- High suspicion of abuse warrants further investigation, including delayed imaging or nuclear scans.