Doctors at the University of Washington and the Seattle Children's Hospital describe how a 13-month-old girl was eventually identified as a child abuse victim, after initially being diagnosed with corneal abrasion and a mild infection. The case study is published in the April issue of the Journal of the American Academy of Pediatric Ophthalmology and Strabismus.
According to estimates, approximately 4% to 6% of child abuse victims see an ophthalmologist first.
Senior author, Avery H. Weiss, M,D,m Roger Johnson Clinical Vision Laboratory, Division of Ophthalmology, Seattle Children's Hospital, explained:
"In retrospect, there were clinical and laboratory findings that might have raised concerns about child abuse earlier in the course of the condition. This troubling case is a reminder to be vigilant for the possibility of child abuse in chronic or recurrent keratoconjunctivitis with dermatitis or an uncertain etiology."
The young girl presented with sensitivity to light, increased tearing and left lower eyelid swelling. In addition, doctors found that her vision was reduced, compared with normal for children her age.
Although the girl received topical and oral antibiotics, her condition progressively worsened over a two week period. The girl was discharged after her condition improved during her three-day stay in the hospital.
However, even though she received continued therapy, the inflammation and irritation persisted. As a result, she was taken to a local trauma hospital where doctors discovered brain hemorrhage and bruising consistent with child abuse.
The doctors confiscated the young girls antibacterial eye drops after they found they had been laced with household bleach. Criminal charges are currently pending.
According to Dr. Weiss, in retrospect, the symptoms the girl presented were more consistent with a locally applied irritant than with infection.
Journal of AAPOS Editor-in-chief David G. Hunter, M.D., Ph.D., also of the Children's Hospital Boston and Harvard Medical School stated:
"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"
Written By Grace Rattue