Ocular Autopsy and Histopathologic Features of Child Abuse

PurposeTo study the ocular histopathologic features in eyes of children with fatal suspected child abuse.DesignRetrospective case series.ParticipantsOne hundred eighteen autopsy cases of known or suspected child abuse.MethodsThe ocular autopsy and histopathologic features of a cohort of consecutive cases of known or presumed child abuse submitted by Maryland’s Office of the Chief Medical Examiner or Johns Hopkins Hospital to the Wilmer Eye Pathology Laboratory were tabulated.Main Outcome MeasureOcular hemorrhage or structural abnormality.ResultsRetinal hemorrhage was present in 44% of cases. Circumferential folds with macular schisis cavities were present in 23% of cases and were bilateral in half of those cases. Peripapillary scleral hemorrhage was present in 38% of cases, and subdural hemorrhage was present in the distal optic nerve in 46% of cases. Hemosiderin was present in 27% of cases.ConclusionsIntraretinal hemorrhages, circumferential macular folds with schisis cavities, peripapillary scleral hemorrhages, and subdural hemorrhages are common pathologic findings in cases of fatal known or suspected child abuse. Their presence on autopsy should raise the suspicion of shaking or blunt nonaccidental trauma.