Related Experiment Video
Updated: Apr 4, 2026
Detection of Polyfunctional T Cells in Children Vaccinated with Japanese Encephalitis Vaccine via the Flow Cytometry Technique
Published on: September 23, 2022
Evaluation of Temporal Association Between Vaccinations and Retinal Hemorrhage in Children
Gil Binenbaum1, Cindy W Christian2, Katy Guttmann3
1Department of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Department of Ophthalmology, The Scheie Eye Institute, Philadelphia, Pennsylvania.
Insights
Retinal hemorrhage is rare in young children and not linked to vaccinations. This study found no evidence that immunizations cause retinal bleeding, refuting a common concern in child abuse cases.
Area of Science:
- Ophthalmology
- Pediatrics
- Forensic Medicine
Background:
- Retinal hemorrhage in children is often linked to abusive head trauma.
- Vaccinations have been questioned as a potential cause of retinal hemorrhage.
- This theory impacts evaluations in suspected child abuse cases.
Purpose of the Study:
- To determine the prevalence and causes of retinal hemorrhage in young children.
- To investigate the temporal association between vaccination and retinal hemorrhage.
- To test the hypothesis that vaccination injections cause retinal hemorrhage.
Main Methods:
- Retrospective cohort study of 5177 children aged 1-23 months.
- Fundus examinations were conducted in pediatric ophthalmology clinics.
- Analysis included immunization records and timing relative to eye exams.
Main Results:
- Retinal hemorrhage prevalence was 0.17%, with all cases linked to abusive head trauma.
- No temporal association was found between vaccination and retinal hemorrhage within 7, 14, or 21 days.
- Only one case of hemorrhage occurred within 14 days of vaccination, with no causal link established.
Conclusions:
- Vaccination injections are not a cause of retinal hemorrhage in children.
- The theory linking vaccinations to retinal hemorrhage is unsupported and should not be clinically or legally accepted.
- Ophthalmologists should consider child abuse evaluations for incidental retinal hemorrhages when no other cause is evident.
Importance:
Vaccinations have been proposed as a cause of retinal hemorrhage in children, primarily as part of a defense strategy in high-stakes abusive head trauma cases. If vaccination injections cause retinal hemorrhage, this consideration would affect the evaluation of children for suspected child abuse.
Objectives:
To describe the prevalence and causes of retinal hemorrhage among infants and young children in an outpatient ophthalmology clinic and to test the hypothesis that, if vaccination injections cause retinal hemorrhage, then retinal hemorrhage would be seen frequently and be temporally associated with immunization.
Design, Setting, And Participants:
Retrospective cohort study between June 1, 2009, and August 30, 2012, at The Children's Hospital of Philadelphia pediatric ophthalmology clinics among 5177 children 1 to 23 months old undergoing a dilated fundus examination as an outpatient for any reason. Children with intraocular surgery or active retinal neovascularization were excluded from the study.
Main Outcomes And Measures:
The prevalence and causes of retinal hemorrhage, as well as the temporal association between vaccination injection within 7, 14, or 21 days preceding examination and retinal hemorrhage.
Results:
Among 7675 outpatient fundus examinations, 9 of 5177 children had retinal hemorrhage for a prevalence of 0.17% (95% CI, 0.09%-0.33%). All 9 had abusive head trauma diagnosable with nonocular findings. Among a subset of 2210 children who had complete immunization records and underwent 3425 fundoscopic examinations, 163 children had an eye examination within 7 days of vaccination, 323 within 14 days, and 494 within 21 days. No children had retinal hemorrhage within 7 days of vaccination, 1 child had hemorrhage within 14 days, and no additional child had hemorrhage within 21 days. There was no temporal association between vaccination injection and retinal hemorrhage in the prior 7 days (P > .99), 14 days (P = .33), or 21 days (P = .46).
Conclusions And Relevance:
Retinal hemorrhage was rare among outpatients younger than 2 years. Considering both immediate and delayed effects, no temporal association existed between vaccination injection and retinal hemorrhage. Vaccination injections should not be considered a potential cause of retinal hemorrhage in children, and this unsupported theory should not be accepted clinically or in legal proceedings. Ophthalmologists noting incidental retinal hemorrhage on an outpatient examination should consider a child abuse evaluation in the absence of other known ocular or medical disease.
