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Characteristics of non-vitreoretinal ocular injury in child maltreatment: a systematic review
Insights
Child maltreatment can cause various non-vitreoretinal ocular injuries, with subconjunctival hemorrhages potentially indicating abuse. However, limited data hinders definitive identification of specific injury patterns in child abuse cases.
Area of Science:
- Ophthalmology
- Pediatrics
- Forensic Medicine
Background:
- Child maltreatment is a significant concern with potential for diverse physical injuries.
- Ocular injuries resulting from abuse require careful identification and diagnosis.
- Non-vitreoretinal injuries are often overlooked in the context of child abuse.
Purpose of the Study:
- To determine the range of non-vitreoretinal ocular injuries associated with child maltreatment.
- To identify potential sentinel signs of ocular abuse in children.
- To assess the quality of existing literature on this topic.
Main Methods:
- Conducted a comprehensive literature search across multiple databases (MEDLINE, PsychINFO, EMBASE, AMED, Web of Science, CINAHL) from 1950 to 2015.
- Included studies with explicit confirmation of injury etiology, patients under 18, and ophthalmologist examination.
- Performed critical appraisal and narrative synthesis of five included studies (three case series, two case reports) involving 26 cases.
Main Results:
- Identified ocular signs including periorbital edema, chemosis, injection, abrasion, hyphaema, and cataract.
- Observed that all children with physical abuse and ocular injury had subconjunctival hemorrhages.
- Noted that abusive ocular injuries were more common in younger children (mean age 13.9 months) compared to those experiencing corporal punishment.
Conclusions:
- While the face is a common site for abusive injuries, high-quality data on non-vitreoretinal ocular injuries is scarce.
- Subconjunctival hemorrhages may serve as a potential indicator of child maltreatment, warranting further investigation.
- The lack of extensive published data limits the ability to establish specific characteristics of non-vitreoretinal ocular injuries indicative of child abuse.
Abstract:
PurposeTo identify the spectrum of non-vitreoretinal ocular injury due to child maltreatment.MethodsAll language search of MEDLINE, PsychINFO, EMBASE, AMED, Web of Science, and CINAHL databases, 1950-2015, was conducted.
Inclusion Criteria:
explicit confirmation of injury aetiology, age <18 years, examination conducted by an ophthalmologist. Exclusion: post-mortem data, organic diseases, review articles. Standardised critical appraisal and narrative synthesis was conducted of included publications by two independent reviewers.ResultsOf 1492 studies identified, 153 full texts were assessed, 49 underwent full review, resulting in five included studies: three case series and two case reports. The 26 included cases describe a wide variety of ocular, facial and skeletal injuries occurring as a consequence of child maltreatment. Ocular signs included periorbital oedema, chemosis, injection, abrasion, hyphaema, and cataract. Of interest all children that had suffered physical abuse with ocular injury had subconjunctival haemorrhages. Children presenting with abusive ocular injuries had a mean age of 13.9 months (range 1-68), while those who suffered violent corporal punishment were considerably older (mean 96 months). All cases, apart from severe corporal punishment, underwent screening for occult fractures, but neuroimaging only apparent in 2/5 eligible cases.ConclusionAlthough, the face is the most common site of abusive injury, there is a paucity of high-quality data on non-vitreoretinal ocular abusive injury. Thus, while subconjunctival haemorrhages are a potential sentinel injury of maltreatment, and may warrant further evaluation, the lack of large-scale published data limits our ability to highlight further specific characteristics of non-vitreoretinal ocular injury indicative of child abuse.
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