Ophthalmologists Urged to Be Alert for Signs of Child Abuse

Case study in the Journal of AAPOS highlights need for vigilance

Philadelphia, PA, April 25, 2012 – It has been estimated that roughly 4% to 6% of child abuse victims present first to an ophthalmologist. In a case study in the April issue of the Journal of American Association of Pediatric Ophthalmology and Strabismus, doctors at the University of Washington and the Seattle Children’s Hospital describe a case of a 13-month-old girl who was initially diagnosed with corneal abrasion and a mild infection. She was eventually identified as a victim of child abuse.

“In retrospect, there were clinical and laboratory findings that might have raised concerns about child abuse earlier in the course of the condition,” says senior author Avery H. Weiss, MD, Roger Johnson Clinical Vision Laboratory, Division of Ophthalmology, Seattle Children’s Hospital. “This troubling case is a reminder to be vigilant for the possibility of child abuse in chronic or recurrent keratoconjunctivitis with dermatitis of an uncertain etiology.”

The child presented with left lower eyelid swelling, sensitivity to light, and increased tearing. Her vision was reduced compared with normal for children her age. She was treated with topical and oral antibiotics, but her condition progressively worsened over the course of two weeks. During a three-day stay in the hospital, her condition improved and she was discharged. Despite continued therapy, the irritation and inflammation persisted. She was then brought to a local trauma hospital with a brain hemorrhage and bruising consistent with child abuse. The patient’s antibacterial eye drops were confiscated, and found to have been laced with household bleach. Criminal charges are pending.

Dr. Weiss notes that looking back, several features of the examination were more consistent with a locally applied irritant than with infection, including the isolated lower eyelid swelling, the inferior corneal abrasion, and inflammation confined to the lower conjunctiva. 

Journal of AAPOS Editor-in-Chief David G. Hunter, MD, PhD, of the Children’s Hospital Boston and Harvard Medical School, comments, “This tragic story of an unexpected manifestation of mental illness serves as a reminder to physicians in all specialties to remain vigilant for child abuse whenever a patient fails to improve despite what appears to be appropriate therapy.” 


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Notes for editors
“Chronic Keratoconjunctivitis with Dermatitis as a Presenting Sign of Child Abuse,” by Daniel B. Moore, MD, Erin P. Herlihy, MD, and Avery H. Weiss, MD, DOI: 10.1016/j.jaapos.2011.11.006. It appears in the Journal of AAPOS, Volume 16, Issue 2 (April 2012) published by Elsevier.

Full text of the article is available at to credentialed journalists upon request; contact Rachael Zaleski at +1 215 239 3658, rachael.zaleski@elsevier.com to obtain a copy or request an interview with the authors.

About the Journal of AAPOS ( http://www.journals.elsevierhealth.com/periodicals/ympa)
Journal of AAPOS presents expert information on children's eye diseases and on strabismus as it impacts all age groups. Major articles by leading experts in the field cover clinical and investigative studies, treatments, case reports, surgical techniques, descriptions of instrumentation, current concept reviews and new diagnostic techniques. The Journal is the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

About the American Association for Pediatric Ophthalmology and Strabismus ( www.aapos.org)
The goals of the AAPOS, the American Association for Pediatric Ophthalmology and Strabismus are to advance the quality of children's eye care, support the training of pediatric ophthalmologists, support research activities in pediatric ophthalmology and advance the care of adults with strabismus.

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