A careful and complete ophthalmologic exam (with dilatation of the pupils) can be an essential part of the evaluation for abusive head trauma, especially in infants.
External changes:
(1) black eye
(2) conjunctival hemorrhage
Retinal hemorrhage:
(1) multiple hemorrhages, often bilateral
(2) usually in the posterior pole and may extend to the peripheral retinal edge
(3) affect several layers of the retina (preretinal, intraretinal, subretinal)
Other changes:
(1) retinoschisis (retinal tear) with or without perimacular retinal folds
(2) intravitreal hemorrhages
(3) decreased visual acuity
(4) macular edema
(5) papilledema
(6) cotton wool spots
(7) retinal detachments
(8) chorioretinal scarring
It is essential to exclude other possible explanations for these changes before the diagnosis of abuse head trauma is made. Confidence in the diagnosis increases if there are compatible injuries in other organ systems.
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