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Christine Shieh, Mehak Aziz, Minas T Coroneo, Gerald W Zaidman, Louise A Mawn; Pediatric Ocular Surface Disease Associated with Suspected Abuse. Invest. Ophthalmol. Vis. Sci. 2019;60(9):924.
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Non-accidental injury (NAI) is a rare, but important, diagnosis to make in pediatric ocular surface disease. While in the absence of admission from a family member, it is impossible to make an absolutely conclusive diagnosis of NAI, the clinician needs to maintain a high degree of concern in unusual and recurring injuries. We describe, to our knowledge, the largest series to date of pediatric patients with ocular surface disease whose etiology was strongly suspected to be NAI.
Retrospective, multi-center case review.
A wide spectrum of anterior segment findings have been noted in our case series and review of the literature. Our case series identifies both: (1) four cases where severe ocular surface disease (necessitating surgery), was presumed to be due to NAI, and (2) the ophthalmic findings of a pair of siblings whose keratitis was ultimately diagnosed by parental slit-lamp examination as related to inherited anterior basement membrane dystrophy. Our case series and literature review suggest that NAI is typically associated with bilateral and recurrent disease, and can also be marked by improvement that is better than expected during hospitalization.
In pediatric patients presenting with ocular surface disease suggestive of NAI, we recommend a thorough history and exam, including assessment of the patient’s corneal sensation, and a slit lamp examination of the parents. In the setting of ocular surface disease that does not respond to treatment, consideration should be given to whether the disease improves when the patient is hospitalized, away from family members.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Table Summary of Patient Clinical and Demographic Details
Clinical images from Case 1. External photographs of the right (A) and left (B) eyes, showing significant symblepharon, cornea opacification, and limbal stem cell deficiency.
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