Child Protection Evidence - Retinal findings

Child Protection Evidence is a resource available for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system. This systematic review evaluates the literature on abusive and non-abusive retinal findings.

About the review

The review examines retinal findings including the presence of retinal haemorrhage in abusive head trauma, retinal haemorrhages in disease states, retinal haemorrhages in newborn infants and children with direct trauma to the eye as a direct consequence of abuse.

The review seeks to identify the features that might be present in these situations as well as features which might distinguish a case from accidental injury.

This systematic review evaluates the scientific literature on retinal injuries published up until February 2020.

It aims to answer the following clinical questions:

  • What differences are found between abusive head trauma retinal findings versus non-abusive head trauma retinal findings?
  • What are the differential diagnoses of retinal haemorrhages in children with clinical features associated with child abuse?
  • Retinal haemorrhages in newborn infants: what are the retinal findings in newborn infants; what are the obstetric correlates to retinal haemorrhages in the newborn; what is the evolution of newborn retinal haemorrhages?
  • Can you date retinal findings in children?
  • Which features or characteristics of eye injury are present in child maltreatment, neglect and fabricated or induced illness?

The implications for practice and research, and other useful references are included in the review.

Key findings

  • The 2020 update included 19 new studies relating to retinal findings in children with a head injury across each of the clinical questions, including the first paper to address the dating of retinal findings.
  • Increasing emphasis has been placed on the detailed pattern of retinal findings and whether these characteristics may aid in distinguishing abusive head trauma from other aetiologies. Ophthalmologists may also encounter children with direct trauma to the eye as a direct consequence of abuse and a recent review highlights the characteristics that may assist in identifying these injuries. To date however there are no large scale comparison studies involving eye injuries due to abuse versus those due to accidental injury.
  • There have been no new studies in 2020 to add to the meta-analysis of studies detailing retinal findings in children less than three years with a head injury. The current meta-analysis highlights the association between retinal haemorrhage and abusive head trauma (odds ratio of 15.31, 95% CI 18.78-25.74).
  • Resolution patterns and duration of retinal haemorrhages measured from sequential retinal imaging has been reported in one new study, adding evidence in a previously unanswered area.

Disclaimer: This is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates

Original reviews and content © Cardiff University, funded by NSPCC
Updates and new material by RCPCH September 2020

While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.