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Editorial |

Ocular Manifestations of Child Abuse

Victor M. Elner, MD, PhD
Arch Ophthalmol. 2008;126(8):1141-1142. doi:10.1001/archopht.126.8.1141.
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Shaken baby syndrome is the most common presentation of child abuse in which ocular and intracranial manifestations are present. It exacts an enormous social, medical, and mental health toll on society. An estimated 30 per 100 000 children per year are victimized, the vast majority of whom being younger than 3 years and most being younger than 1 year. The hallmark of shaken baby syndrome is the triad of encephalopathy, subdural hemorrhages, and retinal hemorrhages.1,2 Although no single component of the triad is pathognomonic, the constellation of these signs is highly specific for nonaccidental head trauma (NAHT) of child abuse and has withstood legal scrutiny.3 Up to 30% of victims die and survivors often have severe and permanent disabilities, including cognitive, motor, visual, and behavioral deficits that may not appear before age 6 years.1,4,5 The most common cause of blindness, occurring in 15% of survivors, is damage to the occipital cortex rather than ocular trauma.68 It is estimated that many children diagnosed with mental retardation are in fact victims of NAHT; other, less severely affected individuals demonstrate learning difficulties.9 The neurological outcomes parallel the patterns and extents of cerebral injuries caused by the trauma.8

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