Ocular manifestations of child abuse.

The ocular manifestations of the "battered baby" or the physically abused child are numerous and play a prominent role in the recognition of this syndrome where the ophthalmologist is sufficiently informed concerning the characteristic features. Nonaccidental trauma must always be considered when examining a child under three years of age exhibiting intraocular hemorrhages, leukocoria, cataract or subluxated lens, retinal detachment or dialysis, Coats' disease, chorioretinal scarring, macular scarring, or periorbital ecchymosis. In addition, certain guidelines including the history, socioeconomic circumstances, general condition of the patient and disproportionate soft tissue injury compared to external signs may help stimulate the awareness of the physician toward the actual etiology. Ophthalmologists may be among the first to examine these traumatized infants so that prompt recognition is urgent since there is a known high incidence of morbidity and mortality. Reporting suspected nonaccidental injuries is required by law in every state. Any district attorney's office or child welfare agency can inform a physician about legal details. Failure to report a suspected case can be a serious misdemeanor in most states.