The leading sign of child abuse is ocular in 4-6% of cases, but the vast majority of abused children have some eye involvement.

While after accidental head injuries nearly all children under 3 years of age have no abnormality on fundus examinations, most babies with nonacci-dental head injuries show retinal hemorrhages of varying degree, occurring in 11-23% of all physically abused children and in 50-80% of shaken babies [9, 18, 24].

On ophthalmoscopy, intraocular hemorrhage can be present in various locations: subretinally; intraretinally; preretinally (subhyaloidally); and intravitreally [17]. The blood is concentrated in the posterior pole region and is usually bilateral. The amount of intraocular blood correlates with the degree of the acute neurological damage [29]. Cotton-wool spots, white-centered hemorrhages (Roth's spot), macular edema, disc edema, and retinoschisis are less common [6, 30].

On CT or MRI, the intracranial pathology includes subarachnoid or intracerebral hemorrhage, cerebral edema, and cerebral atrophy. Elevated intracranial pressure is often present. A variety of neurological symptoms can occur: irritability; lethargy; seizures; and coma. Death should not be an unexpected consequence [31].

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