Risk Factors for Non-Accidental Ocular Trauma and Retinal Hemorrhage in Children

ORCID

0009-0001-4025-4705 (Goodrich), 0000-0001-6705-4132 (Crouch)

Document Type

Article

Publication Date

2026

Publication Title

Investigative Ophthalmology & Visual Science

Volume

67

Issue

7

Pages

2213

Abstract

Purpose: Prior research has established age and race-related disparities in abusive head trauma, yet risk factors for non-accidental ocular injury and retinal hemorrhage (RH) in children remain poorly defined. Using electronic medical record review, this study investigated the clinical and demographic characteristics of pediatric patients with non-accidental ocular trauma, emphasizing RH.

Methods: A retrospective chart review was conducted on patients aged ≤18 years presenting to the emergency department at Children’s Hospital of The King’s Daughters (CHKD) from December 2015 to November 2020, with a final diagnosis of child abuse, child neglect, or child mistreatment. Variables collected included age, sex, race/ethnicity, disability status, abuse/neglect noted in history, identified perpetrator, and ophthalmologic findings. Statistical analyses compared demographics and histories between the total population, those who underwent a formal ophthalmic investigation, and those diagnosed with RH. Similar investigations compared those diagnosed with child abuse, neglect, and mistreatment.

Results: This study included 189 children, with 44 receiving a formal ophthalmic evaluation and 34 being diagnosed with RH. Children diagnosed with RH were significantly younger (mean age 0.69 years) than those in the total population (mean age 4.97 years; p< 0.0001). No significant differences in sex, race/ethnicity, or disability status were observed between cohorts. Abuse was explicitly documented less frequently in the RH cohort (14.7%) compared to the total population (59.3%; p< 0.0001). The RH cohort had a higher rate of an unclear perpetrator (58.8%) compared to the total population (21.7%; p< 0.0001).

Conclusions: Young age, unclear perpetrator identity, and absence of mention of abuse in the clinical history were significant risk factors for non-accidental ocular trauma and RH. In contrast, sex, race/ethnicity, and disability status were not associated with increased risk for RH. These findings highlight the importance of considering age and historical context, especially in preverbal children, when evaluating for non-accidental ocular trauma.

Original Publication Citation

Foster, M., Goodrich, Z., & Crouch, E. (2026). Risk factors for non-accidental ocular trauma and retinal hemorrhage in children. Investigative Ophthalmology & Visual Science, 67(7), 2213. https://iovs.arvojournals.org/article.aspx?articleid=2812225

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