Unilateral retinal hemorrhages in documented cases of child abuse

PURPOSE: To describe the occurrence of unilateral retinal hemorrhages in fo ur cases of documented child abuse, including a case in which retinal hemor rhages were an incidental finding on routine examination. METHODS: Case reports. RESULTS: Three children, 5 to 17 months of age, with suspected child abuse had fundus examinations with a dilated pupil as part of their evaluation. A n additional child, 6 months of age, received fundus examination with a dil ated pupil as parr of follow up for regressed retinopathy of prematurity. E ach of the four children had extensive retinal or preretinal hemorrhages in one eye only. Three of the four had ecchymoses on the ipsilateral face or neck, Two had evidence of bone fractures on skeletal surveys. All four had neuroimaging that documented cerebral hemorrhage or infarct. In all four ca ses an adult caretaker was found responsible for shaking, choking, or squee zing the child. One child died. Two had resolution of retinal hemorrhage, w hereas one required vitrectomy. All three had at least partial recovery of vision in the affected eye after amblyopia treatment. CONCLUSION: In cases of documented child abuse, unilateral retinal or prere tinal hemorrhages may be present. Ophthalmologists should recognize that un ilateral retinal or preretinal hemorrhages may be associated with child abu se. (Am J Ophthalmol 1999;128:340-344. (C) 1999 by Elsevier Science Inc, Al l rights reserved.)