Ocular and associated systemic findings in suspected child abuse. A necropsy study
S. G. Elner, V. M. Elner, M. Arnall and D. M. Albert
Department of Ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor 48105.
We reviewed complete ocular and systemic necropsy findings of 10
consecutive children who died of suspected child abuse. All 10 children had
evidence at necropsy of blunt head trauma, although external signs of blunt
trauma occasionally were covert. Ocular injuries were observed in 7 of the
10 cases and when present always included retinal, vitreous, and subdural
optic nerve hemorrhages. In 5 cases, intrascleral hemorrhage from the
circle of Zinn occurred at the sclera-optic nerve junction. In 4 cases,
traumatic retinoschisis or tractional retinal folds were present. Anterior
segment findings were uniformly consistent with blunt trauma. Hemosiderin,
indicating old hemorrhage, was present in 3 cases. Intracranial hemorrhage,
present in all cases with abnormal ocular findings, was always accompanied
by signs of direct head trauma, such as subgaleal hemorrhage, skull
fracture, cerebral contusion, or external contusions, which are sometimes
subtle or hidden beneath the hair.
