Retinal hemorrhage and bleeding disorders in children: A review

Area of Science:

• Pediatric ophthalmology
• Hematology
• Child abuse and neglect

Background:

• Retinal hemorrhages (RH) are a key indicator of abusive head trauma (AHT).
• Understanding the role of coagulopathy in RH is crucial, as it can co-occur with AHT.
• Differential diagnosis for RH in children necessitates careful consideration of various conditions.

Purpose of the Study:

• To systematically review literature on coagulopathies associated with RH in children.
• To determine if coagulopathies alone can cause RH patterns similar to those seen in AHT.

Main Methods:

• Conducted a literature search for ocular manifestations of bleeding disorders in children under 18.
• Included studies on clotting factor deficiencies, vitamin K deficiency, platelet disorders, DIC, and TIC.
• Analyzed pediatric cases for intraocular bleeding or eye exam findings, re-examining for abuse mimics.

Main Results:

• 61 articles met inclusion criteria, with 32 children under 5 years old exhibiting RH and coagulopathy.
• Only 5 cases presented potential confusion with abuse, lacking classic AHT-associated RH features (e.g., retinoschisis, retinal folds).
• Systemic findings in these cases were inconsistent with AHT.

Conclusions:

• Coagulopathy alone is not a sufficient explanation for RH consistent with AHT.
• The presence of coagulopathy does not exclude the possibility of child abuse.
• Further investigation is needed for cases with both RH and coagulopathy.