Rohrbach J M, Benz D, Friedrichs W, Thiel H J, Wehner H D
Universitäts-Augenklinik Tübingen, Abteilung I.
Klin Monbl Augenheilkd. 1997 Mar;210(3):133-8. doi: 10.1055/s-2008-1035031.
In spite of a growing awareness in the population most cases of child abuse remain probably undetected. Ocular changes in this syndrome are manifold. Sometimes ocular signs can help to substantiate the suspicion of child abuse. On the other hand the ophthalmologist may be the first physician to be contacted. Thus, he plays an important role in diagnosis. Though there are a couple of clinical descriptions morphological data are almost completely missing in the German literature.
A two-year-old girl died two days after severe abuse because of widespread intracranial hemorrhages with brain stem insufficiency. At autopsy both eyes were enucleated and sent for histological investigation.
The anterior segments were unremarkable. Multiple hemorrhages were found in the inner retina bilaterally. Moreover there were preretinal, intrachoroidal, intrascleral (area of the circle of Zinn-Haller) and subdural hemorrhages. One eye showed a circular, perimacular fold of the central retina and a hemorrhagic retinoschisis.
Intraretinal hemorrhages alone are typical though not pathognomonic for the "battered-child syndrome". However, in combination with a crater-like appearance of the central retina, a hemorrhagic retinoschisis; and intrascleral hemorrhages in the area of the circle of Zinn-Haller they suggest child abuse almost with certainty. The pathogenic mechanisms leading to the observed fundus changes lack definite clarification. The date of violence which is essential for legal prosecution can be difficult to evaluate on morphological grounds alone.
尽管公众意识有所提高，但大多数虐待儿童的案例可能仍未被发现。该综合征的眼部变化多种多样。有时眼部体征有助于证实对虐待儿童的怀疑。另一方面，眼科医生可能是首个被联系的医生。因此，他在诊断中起着重要作用。虽然有一些临床描述，但德国文献中几乎完全没有形态学数据。
一名两岁女童在遭受严重虐待两天后因广泛的颅内出血伴脑干功能不全死亡。尸检时双眼被摘除并送去进行组织学检查。
眼前节未见明显异常。双侧视网膜内层发现多处出血。此外，还存在视网膜前、脉络膜内、巩膜内（Zinn-Haller环区域）和硬膜下出血。一只眼睛显示中央视网膜有圆形的黄斑周围皱襞和出血性视网膜劈裂。
单纯视网膜内出血是“受虐儿童综合征”的典型表现，但并非特异性表现。然而，结合中央视网膜的火山口样外观、出血性视网膜劈裂以及Zinn-Haller环区域的巩膜内出血，几乎可以肯定提示虐待儿童。导致所观察到的眼底变化的致病机制尚缺乏明确的解释。对于法律起诉至关重要的暴力发生日期仅根据形态学很难评估。
