Retinal findings: systematic review

Child Protection Evidence is a resource for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion in the legal system.


This systematic review evaluates the scientific literature on vitreo-retinal findings in abusive and non-abusive head trauma in children, non vitreoretinal ocular findings in abusive head trauma, vitreoretinal findings in the newborn and whether retinal findings in abusive head trauma could be dated. The findings from eligible studies published up until February 2020 were included in this review.

The review aims to answer the following clinical questions:

    1. What differences are found between abusive head trauma retinal findings versus non-abusive head trauma retinal findings?
    2. What are the differential diagnoses of retinal haemorrhages in children with clinical features associated with child abuse?
    3. Retinal haemorrhages in newborn infants:
      1. What are the retinal findings in newborn infants?
      2. What are the obstetric correlates to retinal haemorrhages in the newborn?
      3. What is the evolution of newborn retinal haemorrhages?
    4. Can you date retinal findings in children?
    5. Which features or characteristics of eye injury are present in child maltreatment, neglect and fabricated or induced illness?

Questions 1,2 4 and 5 only include children <11 years or where the median age falls within this age range.

The 2020 update included 19 new studies relating to retinal findings in children with a head injury across each of the clinical questions, including the first paper to address the dating of retinal findings.

Key findings:

    • Increasing emphasis has been placed on the detailed pattern of retinal findings and whether these characteristics may aid in distinguishing abusive head trauma from other aetiologies. Ophthalmologists may also encounter children with direct trauma to the eye as a direct consequence of abuse and a recent review highlights the characteristics that may assist in identifying these injuries. To date however there are no large scale comparison studies involving eye injuries due to abuse versus those due to accidental injury.
    • There have been no new studies in 2020 to add to the meta-analysis of studies detailing retinal findings in children less than three years with a head injury. The current meta-analysis highlights the association between retinal haemorrhage and abusive head trauma (odds ratio of 15.31, 95% CI 18.78-25.74).
Disclaimer: This is a summary of the systematic review findings from our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

Original reviews and content © Cardiff University, funded by NSPCC.

Published by RCPCH October 2020.

While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.

VisualV1 - Arrow Created with Sketch. VisualV1 - Arrow Created with Sketch.