Ocular findings in the evaluation of abusive head trauma in children
Sarah K Alswayed1, Sarah S Aldharman1, Jumanah S Alraddadi1
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Insights
Abusive head trauma (AHT) in infants often causes severe eye injuries. Fundus examinations reveal significant ocular damage in most AHT cases, frequently affecting both eyes.
Area of Science:
- Ophthalmology
- Pediatrics
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is a severe form of child physical abuse.
- Ocular injuries are common and significant consequences of AHT.
- Early detection of AHT-related eye damage is crucial for diagnosis and management.
Purpose of the Study:
- To describe the clinical presentation and ocular manifestations of infants diagnosed with AHT.
- To highlight the role of eye examinations in diagnosing AHT in Saudi Arabia.
Main Methods:
- Observational, retrospective, cross-sectional study (2015-2022).
- Inclusion of infants (<2 years) diagnosed with AHT requiring eye examination.
- Data collected from King Abdullah Specialized Children's Hospital (KASCH), Saudi Arabia.
Main Results:
- 25 infants (50 eyes) with AHT underwent eye examinations.
- Majority were males (<6 months) with subdural bleeding (88%).
- Fundus findings were bilateral (72%) in most cases, with retinal hemorrhages (68%) being most common.
Conclusions:
- Fundus examination is vital in evaluating suspected AHT cases.
- Abnormal fundus findings are prevalent in infants with AHT, often bilateral.
- Ocular manifestations are key indicators in the diagnosis of abusive head trauma.
Purpose:
Abusive head trauma (AHT) is a form of child physical abuse that can result in major ocular injuries. This study describes the clinical presentation and ocular manifestations of infants diagnosed with AHT in a tertiary care center in Saudi Arabia.
Methods:
This is an observational, retrospective, cross-sectional study from 2015 to 2022 conducted at King Abdullah Specialized Children's Hospital (KASCH) in Riyadh, Saudi Arabia. Inclusion criteria include infants <2 years of age, diagnosed with AHT that had an eye examination as part of the evaluation.
Results:
A total of 25 (50 eyes) cases of AHT had an eye examination documented in the electronic patients' records. The majority were males 19 (76%), and <6 months of age 10 (40%). About half of the children were healthy 13 (52%), and 12 (48%) had underlying physical illness. All patients had computed tomography scans. Subdural bleeding was noted in 22 (88%), 1 (4%) had epidural, and 4 (16%) had subarachnoid bleed. External ocular signs were noted in 8 (32%) patients only, including raccoon eyes, periorbital bruises, subconjunctival hemorrhage, and nonfixating eyes. Fundus findings were bilateral in 18 (72%), unilateral in 2 (8%), and normal in 5 (20%). In those with findings, the majority of 34 (68%) eyes had multiple retinal hemorrhages, 4 (8%) had vitreous hemorrhages, 2 (4%) retinal detachments, and 1 (2%) retinoschisis.
Conclusion:
Fundus examination is an important part of the comprehensive examination of children with suspected AHT; the majority of patients had an abnormal fundus examination with the tendency of bilateral findings.
