The eye examination in the evaluation of child abuse

Question 1

What are 3 ways of distinguishing hemorrhages?

Answer 1

Type, Pattern and Number

Note: Extent can also be considered to describe Retinal Hemorrhages

Question 2

What are common symptoms for pt. who have suffered an AHT?

Answer 2

Vomiting, Coma and sometimes Seizures

Question 3

What type of forces are associated with Retinal Hemorrhages for children under 5?

Answer 3

Repetitive Acceleration - Deceleration forces with or without blunt head impact

Question 4

What is the best way to detect a Retinal Hemorrhage?

Answer 4

Indirect Ophthalmology with Dilated Pupils

Question 5

What is the protocol when a child aged 5 and under dies suddenly?

Answer 5

The orbital tissue and eyes must be removed.

Question 6

What 3 types of ocular issues can you find with AHT?

Answer 6

Hemorrhages, Pailledema, and Retinoschisis (Splitting if the retinal layers)

Note: Macular Retinochisis is a strong indicator of potential abuse

Question 7

Name an important trend that has been found in young children regarding hemorrhagic retinopathy?

Answer 7

Severe hemorrhagic retinopathy is a strong indicator of AHT.

Note: Vitreoretinal traction and orbital injury sustained during the repetitive acceleration-deceleration mechanism that can distinguish between abuse from a single impact vs. many critical factors.

Question 8

As a Doctor, you are aware this pt. came in 1 week ago with a fracture on their right arm. The same pt. has come back for a follow up and you notice there is another fracture in the similar region. What could this indicate?

Answer 8

Physical Abuse.

Question 9

What internal organs would you see internal injuries?

Answer 9

Duodenum, Jejunum, Pancreas, Spleen and Liver

Question 10

What is the best way to distinguish between inflicted and non inflicted injuries?

Answer 10

Case History

Question 11

What is the primary cause of intracranial bleeds in children less than 2 years of age?

Answer 11

Whiplash Shaken Infant Syndrome

Question 12

What is the leading cause of death in abused infants?

Answer 12

Subdural Hematoma

-Breaking of the Flax Cerebri and Cerebral Vessels

Question 13

A pt. has been brought to you and you suspect Intraocular hemorrhages, other than Direct Ophthalmoscope, what is another method used to back up your theory?

Answer 13

Test for IOP by using NCT machine

Question 14

What is the definition of Terson’s Syndrome?

Answer 14

A rare condition where a hemorrhage has occured in the Vitreous and is associated with a subarchnoid hemorrhage

Question 15

What is Purtscher Retinopathy?

Answer 15

Presense of preretinal and retinal hemorrages without any head injury

Question 16

How does Purtscher Retinopathy occur?

Answer 16

Compression of the thoraic and abdominal cavity

Question 17

In the household, who is typically the abuser?

Answer 17

Mother