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 January 2015.

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

  • There have been no new studies in 2014 to add to the meta-analysis of studies detailing retinal findings in children less than three years with a head injury.
  • Meta-analysis highlights the association between retinal haemorrhage and abusive head trauma (odds ratio of 15.31, 95% CI 18.78-25.74).
  • Ophthalmologists may also encounter children with direct trauma to the eye as a direct consequence of abuse.
  • With the increased use of MRI, recent studies highlight the correlation between intracranial features and retinal haemorrhages.

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
Published by RCPCH July 2017

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.