Binenbaum Gil, Forbes Brian J
The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA,
Pediatr Radiol. 2014 Dec;44 Suppl 4:S571-7. doi: 10.1007/s00247-014-3107-9. Epub 2014 Dec 14.
This review presents an up-to-date overview of ocular injuries resulting from child abuse, with a spotlight on abusive head trauma. Retinal hemorrhage is a principle finding of inflicted head trauma. The specific pattern of hemorrhages holds valuable diagnostic information, which can help to guide multidisciplinary assessments of the likelihood of abuse. Indirect ophthalmoscopy through dilated pupils by an ophthalmologist is necessary for adequate examination and documentation of retinal findings. Initial pediatrician evaluation of the eye and indications for ophthalmological consultation are reviewed. Focus is then placed upon understanding retinal hemorrhage patterns, their diagnostic significance and likely pathophysiological mechanisms. The differential diagnosis of retinal hemorrhage in young children is discussed, highlighting key distinctions among retinal hemorrhage patterns, severity and frequencies, as well as other ocular findings. The most common cause of retinal hemorrhage in an infant is trauma, and most other causes can be identified by considering the hemorrhage pattern, ocular or systemic signs and the results of laboratory and imaging tests, when indicated.
本综述对虐待儿童导致的眼部损伤进行了最新概述，重点关注虐待性头部外伤。视网膜出血是虐待性头部外伤的主要发现。出血的特定模式具有重要的诊断信息，有助于指导对虐待可能性的多学科评估。眼科医生通过散瞳进行间接检眼镜检查对于充分检查和记录视网膜发现是必要的。本文回顾了儿科医生对眼睛的初步评估以及眼科会诊的指征。接着重点在于理解视网膜出血模式、其诊断意义及可能的病理生理机制。讨论了幼儿视网膜出血的鉴别诊断，突出了视网膜出血模式、严重程度和频率以及其他眼部发现之间的关键区别。婴儿视网膜出血最常见的原因是外伤，大多数其他原因可通过考虑出血模式、眼部或全身体征以及必要时的实验室和影像学检查结果来确定。
