Abusive head trauma and the eye in infancy

Abusive head trauma is a leading cause of traumatic death in infants. Retinal haemorrhages (RHs) can be the earliest and only clinically visible evidence of the aetiology, making the ophthalmic examination a critical component in triggering child protection pathways. 1 Diagnostic difficulties arise from potential overlap with non-abusive conditions such as coagulopathies, birth trauma or artefacts from resuscitation, which can produce RHs that sometimes resemble those seen in abuse.2 3 Considering this, ophthalmological examination must be used as part of a detailed and comprehensive examination and set of investigations as per the child protection companion.4 This updated guideline reflects the need for robust, standardised documentation of ophthalmic findings that can withstand scrutiny in medico-legal settings.