Betts T, Ahmed S, Maguire S, Watts P
Ophthalmology Registrar, University Hospital of Wales, Cardiff, UK.
Cardiff University, Cardiff, UK.
Eye (Lond). 2017 Aug;31(8):1146-1154. doi: 10.1038/eye.2017.25. Epub 2017 Mar 24.
PurposeTo identify the spectrum of non-vitreoretinal ocular injury due to child maltreatment.MethodsAll language search of MEDLINE, PsychINFO, EMBASE, AMED, Web of Science, and CINAHL databases, 1950-2015, was conducted.
explicit confirmation of injury aetiology, age <18 years, examination conducted by an ophthalmologist. Exclusion: post-mortem data, organic diseases, review articles. Standardised critical appraisal and narrative synthesis was conducted of included publications by two independent reviewers.ResultsOf 1492 studies identified, 153 full texts were assessed, 49 underwent full review, resulting in five included studies: three case series and two case reports. The 26 included cases describe a wide variety of ocular, facial and skeletal injuries occurring as a consequence of child maltreatment. Ocular signs included periorbital oedema, chemosis, injection, abrasion, hyphaema, and cataract. Of interest all children that had suffered physical abuse with ocular injury had subconjunctival haemorrhages. Children presenting with abusive ocular injuries had a mean age of 13.9 months (range 1-68), while those who suffered violent corporal punishment were considerably older (mean 96 months). All cases, apart from severe corporal punishment, underwent screening for occult fractures, but neuroimaging only apparent in 2/5 eligible cases.ConclusionAlthough, the face is the most common site of abusive injury, there is a paucity of high-quality data on non-vitreoretinal ocular abusive injury. Thus, while subconjunctival haemorrhages are a potential sentinel injury of maltreatment, and may warrant further evaluation, the lack of large-scale published data limits our ability to highlight further specific characteristics of non-vitreoretinal ocular injury indicative of child abuse.
目的确定虐待儿童导致的非玻璃体视网膜眼损伤的范围。方法对1950 - 2015年的MEDLINE、PsychINFO、EMBASE、AMED、Web of Science和CINAHL数据库进行全语言检索。
明确确认损伤病因，年龄<18岁，由眼科医生进行检查。排除：尸检数据、器质性疾病、综述文章。由两名独立评审员对纳入的出版物进行标准化的批判性评价和叙述性综合分析。结果在检索到的1492项研究中，评估了153篇全文，49篇进行了全面审查，最终纳入5项研究：3个病例系列和2个病例报告。纳入的26例病例描述了因虐待儿童而发生的各种眼部、面部和骨骼损伤。眼部体征包括眶周水肿、球结膜水肿、充血、擦伤、前房积血和白内障。有趣的是，所有遭受身体虐待并伴有眼损伤的儿童都有结膜下出血。遭受虐待性眼损伤的儿童平均年龄为13.9个月（范围1 - 68个月），而遭受暴力体罚的儿童年龄则大得多（平均96个月）。除严重体罚外，所有病例均接受了隐匿性骨折筛查，但仅2/5符合条件的病例有神经影像学检查结果。结论尽管面部是虐待性损伤最常见的部位，但关于非玻璃体视网膜眼虐待性损伤的高质量数据很少。因此，虽然结膜下出血是虐待的潜在警示性损伤，可能需要进一步评估，但缺乏大规模发表的数据限制了我们突出非玻璃体视网膜眼损伤进一步表明虐待儿童的具体特征的能力。
