Certain lesions seen on fundoscopic examination of a physically abused child can indicate severe central nervous system injury with high morbidity and mortality. Recognition of these lesions can help identify a child who requires more aggressive therapy or who may have a guarded prognosis.


Findings associated with more severe neurologic injury:

(1) circular perimacular retinal fold

(2) peripheral retinoschisis (retinal tear)

(3) retinal detachment

(4) lack of visual response (failure to respond to any visual stimulus)

(5) lack of pupillary response

(6) vitreous hemorrhage

(7) extensive retinal or preretinal hemorrhage


Other findings less predictive of severe injury:

(1) less extensive retinal and preretinal hemorrhage

(2) optic nerve hemorrhage

(3) anisocoria


The presence of one or more of the findings associated with a severe neurologic injury indicates that the prognosis may be poor.


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