Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus · 2026
Assessing the incidence of retinal hemorrhage in pediatric patients following COVID-19 vaccination.
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Wong Brittany M, Perkins Jacob M, Zontag Nir, Levin Alex V
Аннотация
BACKGROUND: Retinal hemorrhages (RHs) are a cardinal finding in abusive head trauma (AHT) for which a broad differential diagnosis is appropriate to consider. The frequency of COVID-19 vaccination and reports of subsequent ocular manifestations have led to the consideration of whether COVID-19 vaccination should be included in the RH differential. This study aimed to investigate the frequency of RH following COVID-19 vaccination in children.
METHODS: In this single-center, retrospective, observational cohort study, we reviewed the medical records of children ≤8 years of age who received a COVID-19 vaccine from July 1, 2020, to July 1, 2024, and underwent a fundus examination within 21 days of vaccination. The main outcome measure was incidence and characteristics of RH on fundus examination.
RESULTS: Of 17,926 children vaccinated during this period, 203 subjects met inclusion criteria and underwent 212 unique examinations, with mean age of 4.56 years (0-8) at the time of first examination. Twenty examinations were also in the setting of prior COVID-19 infection. No examinations revealed RH. Based on Hanley's rule of zero incidence, the 95th percentile upper limit of incidence of RH after COVID-19 vaccination is 4.11% at 7 days, 2.04% at 14 days, and 1.42% at 21 days following vaccination.
CONCLUSIONS: RHs were not seen in any children within 21 days of COVID-19 vaccination. This suggests that RH is rare following COVID-19 vaccination and perhaps of little relevance to the differential diagnosis of RH in the evaluation for AHT.
METHODS: In this single-center, retrospective, observational cohort study, we reviewed the medical records of children ≤8 years of age who received a COVID-19 vaccine from July 1, 2020, to July 1, 2024, and underwent a fundus examination within 21 days of vaccination. The main outcome measure was incidence and characteristics of RH on fundus examination.
RESULTS: Of 17,926 children vaccinated during this period, 203 subjects met inclusion criteria and underwent 212 unique examinations, with mean age of 4.56 years (0-8) at the time of first examination. Twenty examinations were also in the setting of prior COVID-19 infection. No examinations revealed RH. Based on Hanley's rule of zero incidence, the 95th percentile upper limit of incidence of RH after COVID-19 vaccination is 4.11% at 7 days, 2.04% at 14 days, and 1.42% at 21 days following vaccination.
CONCLUSIONS: RHs were not seen in any children within 21 days of COVID-19 vaccination. This suggests that RH is rare following COVID-19 vaccination and perhaps of little relevance to the differential diagnosis of RH in the evaluation for AHT.