Researchers say criterion for diagnosing child abuse not always accurate

WINSTON-SALEM, N.C. When it comes to looking for damage to the eyes to prove child abuse, new research shows that things aren't always as they seem, according to Patrick Lantz, M.D., a forensic pathologist from Wake Forest University Baptist Medical Center.

"Contrary to what many doctors have been taught, we found that number and location of hemorrhages of the eye's retina aren't always proof of child abuse," said Lantz, who reported the results today at the 58th annual meeting of the American Academy of Forensic Sciences in Seattle. "Retinal hemorrhages occur more often than most doctors think are associated with a wide variety of conditions."

Lantz found that about 16 percent of the 700 individuals he examined during autopsy had hemorrhages of the retina, which is light-sensitive nerve tissue at the back of the eye. The bleeding occurs when tiny blood vessels on the retina's surface rupture. Lantz found the hemorrhages in individuals who had died from ruptured aneurysms, falls, car wrecks, gunshot wounds, meningitis and even drug overdose.

"Our research shows that you see the hemorrhages in a lot of different situations," Lantz said. "Retinal hemorrhages occur in child abuse, but they don't always mean a child was abused. Unfortunately, many pathologists, pediatricians and ophthalmologists have been taught that retinal hemorrhages are diagnostic of child abuse unless the child was involved in a high-speed car crash or fell more than two stories."

Currently, when child abuse is suspected, doctors conduct an eye exam to look for retinal hemorrhages and other eye changes that are considered proof of child abuse. Lantz got the idea to question this common assumption after he found that another eye condition, a buckling of the retina, is not always diagnostic for shaken baby syndrome. He reported those results in the British Medical Journal.

To test his theory that retinal hemorrhages also may not always be indicative of child a

Contact: Karen Richardson
Wake Forest University Baptist Medical Center

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