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Published on: April 18, 2011
Globe rupture and nonaccidental trauma: two case reports
Sara Elizabeth Skarbek-Borowska1, Karen Taggart Campbell
1Department of Emergency Medicine, Division of Pediatric Emergency Medicine, The University of New Mexico Health Sciences Center, Albuquerque, NM 87131-0001, USA. sskarbek@salud.unm.edu
Insights
Nonaccidental trauma can cause globe rupture in infants and toddlers. A thorough evaluation for child abuse is crucial when globe rupture occurs, especially with inconsistent injury history.
Area of Science:
- Ophthalmology
- Pediatric Trauma
- Child Abuse Forensics
Background:
- The link between globe rupture and nonaccidental trauma lacks established literature.
- Globe rupture in young children necessitates a high index of suspicion for inflicted injury.
- Understanding the presentation of traumatic globe rupture in infants is critical for diagnosis.
Observation:
- Two cases of inflicted traumatic globe rupture in infants (9-month-old and 14-month-old girls) are presented.
- Initial presentations showed isolated ocular findings, masking more extensive injuries.
- Skeletal surveys and head CT scans revealed additional injuries in both cases.
Findings:
- Nonaccidental trauma should be strongly considered in pediatric globe rupture cases.
- Isolated eye findings can be deceptive, underscoring the need for comprehensive evaluation.
- A history inconsistent with the observed injury warrants further investigation for abuse.
Implications:
- Healthcare providers must consider nonaccidental trauma in infants and toddlers with globe rupture.
- Complete child abuse evaluations are essential when history is absent or contradictory.
- Early recognition and intervention can mitigate long-term consequences of child abuse and trauma.
Abstract:
The association of globe rupture and nonaccidental trauma is not established in the literature. We present 2 cases involving a 9-month-old infant girl and a 14-month-old girl who experienced inflicted traumatic globe rupture. In the first case, the infant had isolated eye findings on physical examination, but extensive injuries were revealed on the skeletal survey and computed tomography of the head. In the second case, the toddler had a prior history of abuse, so our index of suspicion for nonaccidental trauma was heightened. Despite isolated eye findings on physical examination, this toddler also had evidence of additional injury on skeletal survey. These cases illustrate the importance of considering nonaccidental trauma in infants and toddlers who present with globe rupture and performing a complete evaluation for child abuse if no history is given or if the history is inconsistent with the injury.
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