Ocular Autopsy and Histopathologic Features of Child Abuse
Presented at: American Academy of Ophthalmic Pathologists Annual Meeting, October 2004, New Orleans, Louisiana.
Received 5 March 2005; accepted 16 April 2007.
Purpose
To study the ocular histopathologic features in eyes of children with fatal suspected child abuse.
Design
Retrospective case series.
Participants
One hundred eighteen autopsy cases of known or suspected child abuse.
Methods
The ocular autopsy and histopathologic features of a cohort of consecutive cases of known or presumed child abuse submitted by Maryland’s Office of the Chief Medical Examiner or Johns Hopkins Hospital to the Wilmer Eye Pathology Laboratory were tabulated.
Main Outcome Measure
Ocular hemorrhage or structural abnormality.
Results
Retinal hemorrhage was present in 44% of cases. Circumferential folds with macular schisis cavities were present in 23% of cases and were bilateral in half of those cases. Peripapillary scleral hemorrhage was present in 38% of cases, and subdural hemorrhage was present in the distal optic nerve in 46% of cases. Hemosiderin was present in 27% of cases.
Conclusions
Intraretinal hemorrhages, circumferential macular folds with schisis cavities, peripapillary scleral hemorrhages, and subdural hemorrhages are common pathologic findings in cases of fatal known or suspected child abuse. Their presence on autopsy should raise the suspicion of shaking or blunt nonaccidental trauma.
Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Correspondence and reprint requests to M. Vaughn Emerson, MD, Wilmer B-20, 600 North Wolfe Street, Baltimore, MD 21287.
Manuscript no. 2005-195.
The authors have no financial interests in the products or devices mentioned herein.
ABSTRACT