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Severe, multilayered retinal hemorrhages (RHs) with retinoschisis in infants are highly specific indicators of abusive head trauma, distinguishing it from other causes.

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Area of Science:

  • Ophthalmology
  • Pediatrics
  • Forensic Medicine

Background:

  • Abusive head trauma (AHT) is a significant cause of infant morbidity and mortality.
  • Retinal hemorrhages (RHs) are common findings in children with AHT.

Purpose of the Study:

  • To review the evaluation of children with RHs.
  • To differentiate RHs caused by AHT from other etiologies.
  • To discuss the pathophysiology and distinguishing features of AHT-related RHs.

Main Methods:

  • Review of existing literature on retinal hemorrhages in children.
  • Focus on differential diagnosis and distinguishing features of AHT-related RHs.
  • Discussion of ophthalmologic consultation indications and examination timing.

Main Results:

  • Non-AHT causes of RHs typically present nonspecific patterns.
  • Severe, multilayered RHs extending to the retinal periphery, especially with retinoschisis, are specific to AHT.
  • Retinoschisis is rarely associated with accidental trauma, and such events are usually well-documented.

Conclusions:

  • Ophthalmologic findings, particularly severe peripheral RHs with retinoschisis, are critical in diagnosing AHT.
  • Distinguishing AHT-related RHs from other causes is crucial for appropriate child protection.
  • Understanding the significance of specific RH patterns aids in timely diagnosis and intervention.