Retinal Findings in Nonaccidental Abusive Head Trauma in an Infant: A Case Report

Nonaccidental head trauma, also known as abusive head trauma or battered baby syndrome, is a life-threatening form of child abuse. The ocular findings, particularly retinal hemorrhages (RH) and Roth spots, serve as critical diagnostic clues. Here, we report an extremely rare case of a nine-month-old male infant presenting with vomiting, seizures, and altered sensorium, in whom fundoscopic examination revealed innumerable Roth spots with multilayered RH extending to the periphery, bilateral concentric retinal folds with posterior hyaloid attachment suggestive of retinoschisis, and right eye subhyaloid hemorrhage with posterior hyaloid detachment. Follow-up revealed a full-thickness macular hole in the right eye. The CT scan showed bilateral subdural hemorrhage. Systemic investigations ruled out hematological, infectious, and cardiac etiologies. This cluster of findings was diagnostic of nonaccidental head trauma. This case underscores the indispensable role of ophthalmic examination in infants with unexplained neurological presentations and the need for a multidisciplinary approach in suspected child abuse.