Ocular autopsy and histopathologic features of child abuse.
OBJECTIVE
To study the ocular histopathologic features in eyes of children with fatal suspected child abuse.


METHODS
Retrospective case series.


METHODS
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.


METHODS
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.
Emerson
M Vaughn
MV
Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Jakobs
Elisabeth
E
Green
W Richard
WR
D001344:Autopsy; D002493:Central Nervous System Diseases / Q000453:epidemiology / Q000473:pathology; D002648:Child; D002649:Child Abuse / Q000401:mortality; D002675:Child, Preschool; D005123:Eye / Q000473:pathology*; D005130:Eye Hemorrhage / Q000453:epidemiology* / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000473:pathology; D006485:Hemosiderin / Q000378:metabolism; D006801:Humans; D007223:Infant; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D009900:Optic Nerve / Q000473:pathology; D012166:Retinal Hemorrhage / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D012590:Sclera / Q000473:pathology; D013355:Subdural Space / Q000473:pathology
D006485:Hemosiderin