children include anemia, hypertension, increased intracranial pressure, leukemia, meningitis, glutaric aciduria, and retinopathy of prematurity.

American Academy of Ophthalmology. Information Statement. Abusive Head Trauma/ Shaken Baby Syndrome. San Francisco: American Academy of Ophthalmology; 2010. Available at http://one.aao.org/guidelines-browse?filter=clinicals tatement. Accessed February 19, 2014.

Christian CW, Block R; Committee on Child Abuse and Neglect; American Academy of Pediatrics. Abusive head trauma in infants and children. Pediatrics. 2009;123(5):1409–1411.

Prognosis

In one large study, 29% of children with AHT died of their injuries. Poor visual and pupillary responses were correlated with a higher risk of mortality. Survivors often had permanent impairment ranging from mild learning disability and motor disturbances to severe cognitive impairment and quadriparesis. The most common cause of vision loss is from cortical injury followed by optic atrophy. Dense vitreous hemorrhage, usually associated with deep traumatic retinoschisis, carries a poor prognosis for both vision and life.

Ocular Injury Secondary to Nonaccidental Trauma

The presenting sign of child abuse involves the eye in approximately 5% of cases. Blunt trauma inflicted with fingers, fists, or implements such as belts or straps is the usual mechanism of nonaccidental injury to the ocular adnexa or anterior segment. Periorbital ecchymosis, subconjunctival hemorrhage, and hyphema should raise suspicion of recent abuse if the explanation provided is implausible (see the section “Hyphema” earlier in this chapter). Cataract and lens dislocation may be a sign of repeated injury or trauma inflicted earlier. Child abuse should also be suspected with rhegmatogenous retinal detachment in a child without a history of injury or an apparent predisposing factor, such as high myopia.