Ocular findings in the evaluation of abusive head trauma in children.

Abstract

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.