Assessing the incidence of retinal hemorrhage in pediatric patients following COVID-19 vaccination.

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.