Abusive head trauma (AHT) in young children results from repeated acceleration-deceleration injury with or without blunt head impact [1-4]. Characteristic clinical features include retinal hemorrhages (often bilateral, multilayered, and extensive), subdural hematoma, and/or occult fractures (particularly of the ribs and long bone metaphyses). Multiple episodes of trauma may occur before the abuse is detected [5-8]. Early recognition can be lifesaving.
The ophthalmologic aspects of abusive head trauma will be reviewed here. The pathogenesis of retinal hemorrhages in AHT, other aspects of AHT, and the management of suspected child abuse are discussed separately:
Child abuse is an important cause of death in children. Among child abuse fatalities, head injury is the leading cause of death in infancy. Mortality rates in series of cases of AHT range from approximately 15 to 25 percent. The epidemiology and risk factors for physical abuse and abusive head trauma are discussed separately. (See "Physical abuse in children: Epidemiology and clinical manifestations" and "Child abuse: Epidemiology, mechanisms, and types of abusive head trauma in infants and children" and "Child abuse: Evaluation and diagnosis of abusive head trauma in infants and children", section on 'Outcome'.)
Children with AHT commonly have abnormal eye findings such as hemorrhages of the retina, vitreous, or optic nerve sheath and perimacular retinal folding or retinoschisis . For example, in a systematic review of 20 observational studies with results of eye examination in 973 victims of abuse, intraocular hemorrhage (retinal or vitreous hemorrhage) was seen in approximately 85 percent of children with AHT. Thus, a careful funduscopic examination, preferably by an ophthalmologist, is indicated in all children in whom AHT is suspected. (See 'Ophthalmology consultation' below.)