Ocular Manifestations of Elder Abuse

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Article initiated by:
Hashem Abu Serhan
All contributors:
Mahmoud Anwar, Taima Mahmoud Mousa AlAwaysheh, Nada S. Jibril, Oase Sbei, Mohd Salim Harun Gigani, Michael T Yen, MD, Hashem Abu Serhan
Assigned editor:
Shannon S. Joseph, M.D.
Review:
Assigned status Up to Date
 by Michael T Yen, MD on December 24, 2025.


Disease Entity

Elder abuse refers to the intentional or unintentional causing of harm, suffering, or distress to an older person within a relationship of trust. It is more prevalent than once believed, with statistics in Australia indicating that one in six older adults has experienced some form of mistreatment, most often occurring within the home environment. The current site is close to the home. Abuse occurs commonly among family members, particularly adult offspring. They are generally hidden and insufficiently reported. 61 percent of mistreated elders do not seek help.[1][2]

The increasing elderly population has led to rising instances of abuse by family members and friends in both domestic and long-term care settings, posing significant public health and criminal justice challenges. Mistreatment of individuals over the age of 60 by relatives or acquaintances, whether in their own homes or in care facilities, has become an escalating concern in these sectors. The worldwide senior population is expected to grow from 542 million in 1995 to 1.2 billion by 2025, with 27% of Canadians aged 60 and over, up from 14% in 2009.[3]

Elder abuse can result in several systemic and localized injuries, including ocular signs such as periorbital ecchymosis, subconjunctival hemorrhage, hyphema, retinal hemorrhage, and orbital fractures, which may serve as significant clinical markers of underlying maltreatment.[4][5][6]

Disease

The World Health Organization and the International Network for the Prevention of Elder Abuse define elder abuse as "a single or repeated act, or the failure to take appropriate action, occurring in any relationship based on an expectation of trust that causes harm or distress to an older person.[1][7]  Clinical and legal sources commonly classify abuse as neglect, physical abuse, sexual abuse, financial or material abuse, and psychological or emotional abuse. In 2008, 17.1% of older Americans were mistreated, while 1.6% were physically abused.[8] In 2009, Statistics Canada reported 7,900 adult abuse incidents to police, 14% higher than in 2004.[3] Canadian statistics show that adult family homicides have remained stable over 15 years. Over the past 30 years, family killings have decreased, with the rate in 2010 41% lower than in 1980. Therefore, it is unclear if the growth in elder abuse cases is related to greater abuse or more awareness.[3][8]

Etiology

Numerous detrimental behaviors or failures within relationships based on trust can lead to elder abuse. It includes several types, each with unique processes that might result in ocular and systemic damage:[4][8]

Physical abuse encompasses actions from slapping or shoving to severe beatings and confinement with ropes or chains. When a caregiver or another individual employs excessive force resulting in unnecessary suffering or harm, regardless of the intent to assist the elderly individual, such conduct may be deemed abusive. Physical abuse includes actions such as punching, beating, pushing, shoving, kicking, pinching, burning, or biting. It also includes the improper utilization of drugs, physical restrictions, and any form of physical punishment.[8][9]

Verbal and emotional abuse encompasses shouting, cursing, threatening, making derogatory or disrespectful remarks, and consistently disregarding the older adult.[9][10]

Psychological abuse encompasses any coercive or threatening action that establishes a power imbalance between the older adult and their family member or caregiver. It may also involve infantilizing the elderly individual and segregating them from family, friends, and customary activities.[4][9]

Sexual abuse includes improper touching, photographing the elderly individual in provocative positions, coercing the person to see pornography, and any unsolicited sexualized conduct.[4][10]

Financial abuse encompasses the misappropriation of an elderly individual's assets, including embezzlement. It may encompass check forgery, misappropriation of another individual's retirement or Social Security payments, or unauthorized use of a person's credit cards and bank accounts. It also encompasses altering names on a will, bank account, life insurance policy, or property title without authorization.[9][10]

Caregiver neglect, whether deliberate or inadvertent, entails the purposeful failure to address the medical, social, or emotional requirements of the elderly individual. Neglect may encompass the omission of essential provisions such as food, drink, clothes, prescriptions, and support for daily tasks or personal hygiene.[4][8]

Risk Factors

Caregiver-Related Factors

·      High caregiver stress and burnout (“caregiver stress hypothesis”)

·      Hostile or disruptive patient behaviors (e.g., wandering, humiliation, explosive outbursts).

·      History of strained caregiver–elder relationships.

·      Low self-esteem or poor coping skills in the caregiver.

·      Substance abuse, particularly alcohol.

·      Mental illness, criminal behavior, or deviant tendencies in the caregiver.

·      Emotional or financial dependence on the elder.

·      Interpersonal conflict increases neglect risk.

·      Cohabitation with the elder during periods of high stress. [9][10]

Victim-Related Factors

·      Dementia or cognitive impairment, particularly with aggression or inability to perform activities of daily living (ADLs).

·       Poor physical health or chronic illness.

·       Females are more frequently affected, possibly due to greater injury severity and higher reporting rates.

·      Lack of social support or confidants.

·      Living alone, increasing risk of neglect or financial exploitation.

·      Functional dependence in ADLs, especially feeding.

·      In certain contexts, elderly married men may be at higher risk of spousal abuse.[4][9]

Relationship / Household Factors

·      Shared housing increases verbal and physical aggression risk.

·       Living alone increases vulnerability to financial exploitation.

·      Long-standing cohabitation with a spouse can sometimes indicate the presence of an abuser.

·      “Generation inversion” - elder entirely dependent on caregiver for all needs. [8]

Sociodemographic and Cultural Factors

·      No consistent association with religion, education, income, or alcohol consumption.

·      Ethnicity: No clear racial disparities, though some minorities are studied more frequently.

·      Cultural barriers to disclosure exist, such as Korean Americans underreporting their issues due to a sense of "family shame."

·      Urban vs. rural residence: Mixed findings; some studies report no difference.[8]

General Pathology

Elder abuse includes purposeful acts and omissions that damage, distress, or deprive older individuals. It causes degenerative alterations, many of which may impact the ocular and periocular area; however, it is not a disease.[4]

Injury Mechanisms

The most severe form of abuse is physical, encompassing blunt force trauma, slapping, kicking, burning, biting, hair-pulling, inappropriate restraint, and the misuse of medication. Unusual positions (inner arms, axilla, mastoid, periocular area) or patterns suggest inflicted trauma. Lesions at varying stages of healing indicate repetitive damage. Sexual assault can produce facial contusions, palatal lacerations, and periocular bruises in addition to anogenital injuries. Active or passive neglect causes starvation, dehydration, poor hygiene, and untreated medical or visual problems.[11][12]

Eye and Periocular Pathology

Soft tissue injury: Head trauma commonly causes bilateral periorbital ecchymosis, subconjunctival bleeding, eyelid lacerations, and periocular edema. Blunt contact can cause hyphema, corneal abrasions, lens displacement, vitreous hemorrhage, retinal hemorrhage, and retinal detachment. Blow-out orbital floor or medial wall fractures can impede ocular mobility. Withheld medical treatment can cause untreated cataract, end-stage glaucoma, corneal ulceration, or exposure keratopathy in bedbound patients. Pattern recognition: Ocular injuries in odd distributions, contradictory with the report, or with suspicious lesions (mastoid ecchymosis, buccal mucosa bruises) suggest nonaccidental trauma. [5][6]

Age-related imitators

Normal aging changes must be recognized to avoid misdiagnosis: Minimal trauma can elicit senile purpura or subconjunctival bleeding due to vascular fragility. Dermal atrophy can cause eyelid skin tears. Anticoagulants and bleeding diatheses can resemble trauma. Nature-induced advanced eye illness must be separated from neglect.[6] [12]

Systemic Associations

Elder abuse frequently involves many systems. Severe head injuries often result in subdural bleeding. Ribs, vertebrae, and unusual facial bones can break. Individuals who smoke or immerse themselves may sustain burns, which can also affect the distribution of gloves and stockings. Long-term immobility causes friction burns, ligature scars, and decubitus ulcers. Low BMI, hypoalbuminemia, electrolyte imbalance, and postmortem vitreous chemistry indicate malnutrition/dehydration. [4][6]

Inquiries

Clinical, laboratory, and radiologic results must be correlated for accurate diagnosis. Slit-lamp, fundus, orbital, and photographic recording are essential for ocular cases. Suspect injuries in varied healing phases, conflicting histories, or delayed presentation.[4]

Pathophysiology

Ocular Manifestations

The eye and periocular region are common sites of injury in elder maltreatment because of the face’s prominence as a target during assault and the fragility of periocular tissues in older adults. [5]

Although isolated case descriptions appear sporadically in the literature, formal recognition of ocular injury as a sentinel sign of elder abuse has grown since the late 20th century, with reports linking periorbital bruising, subconjunctival hemorrhage, and orbital fractures to confirmed nonaccidental trauma in older patients.[13]

External and Adnexal Findings

Periorbital ecchymosis, commonly referred to as a "black eye," may appear on both sides or present in different stages of healing, often inconsistent with the stated cause. Eyelid swelling, cuts, and abrasions can result from blunt trauma, fingernail scratches, or sharp objects. Loss of eyelashes or eyebrow hair may indicate traumatic alopecia from hair-pulling. Thermal injuries, such as periocular burns from cigarettes or scalding liquids, may also occur, sometimes displaying distinct patterned edges..[5][6]

Ocular Surface and Anterior Segment

Subconjunctival hemorrhage—often seen after blunt periocular trauma—should prompt concern if extensive or recurrent without an obvious cause. Other ocular findings may include corneal abrasions, the presence of foreign bodies, chemical burns, hyphema[14], and traumatic cataract.[15]

Posterior Segment and Globe

Retinal hemorrhages may result from direct globe trauma or as a consequence of violent shaking or asphyxia. Vitreous hemorrhage can occur due to severe contusion or penetrating injury.[5][6] Retinal detachment may occur as a result of blunt trauma or globe rupture. Globe rupture and penetrating injuries are associated with severe assaults involving sharp objects or high-energy blunt trauma.[13]

Orbital and Facial Skeletal Injuries

Orbital fractures include blow-out fractures of the floor or medial wall, which may result in diplopia or restricted gaze. Zygomatic or maxillary fractures are frequently associated with significant periocular swelling. Nasal fractures may also occur concurrently with orbital injuries.[5][13]

Ocular Pathology Linked to Neglect

This condition involves advanced cataract, which leads to considerable visual impairment, advanced glaucoma due to noncompliance to treatment, exposure keratopathy and corneal ulcers occur in immobile or paralyzed individuals lacking eyelid closure or ocular lubrication, acute dry eye syndrome resulting from persistent dehydration and environmental disregard.[13]

Clinical Indicators Indicative of Abuse

Injuries occur at different stages of recovery, lesions that do not align with the described process are present, delayed presentation, ocular damage coexists with other suspicious lesions, such as mastoid ecchymosis, buccal mucosa contusions, and patterned burns. [4][12]

Primary Prevention

The primary strategy to prevent elder abuse and neglect is to improve awareness and comprehension among emergency doctors and other healthcare professionals. By recognizing high-risk individuals and families, physicians may alleviate mistreatment by directing them to appropriate social services and community groups. Examples include respite care, homemaker services, home nursing, day programs, and accessible transportation. Emergency physicians may provide aid and information on high-risk situations directly to patients.[16]

Besides providing clinical expertise, the emergency physician may substantially enhance the promotion and involvement in research about elder abuse and neglect. Elder abuse is acknowledged as a societal concern including the requirements of elderly folks, therapeutic interventions, and preventive measures. In conjunction with data collection methods, there is a critical need for efficient and effective regulations to protect both the vulnerable elderly and the whistleblowers.[17]

Diagnosis

History

Diagnosis of ocular manifestations of elder abuse begins with a comprehensive history, ideally obtained from both the patient and collateral sources. Key historical elements include a detailed account of the incident, the mechanism of injury if trauma occurred, and the timeline of symptom onset. History should also document any prior injuries, particularly multiple injuries in various stages of healing, as this may suggest repeated abuse. Medical history should include conditions that could predispose to ocular or systemic bleeding such as bleeding disorders, diabetes mellitus, and hypertension. Clarification of inconsistencies between the reported mechanism of injury and the severity or pattern of ocular findings is critical. [18]

Physical Examination

A complete ophthalmic and systemic examination should be performed, beginning with external inspection of the periorbital region for ecchymosis, lid edema, lacerations, and orbital deformities. The anterior segment should be assessed for hyphema, iris prolapse, corneal lacerations, lens dislocation, or traumatic cataract. Posterior segment evaluation via dilated fundus examination should carefully look for vitreous hemorrhage, retinal detachment, optic nerve avulsion, or retinal hemorrhages. Associated neurologic injury may present as nystagmus, cortical blindness, encephalopathy, or cranial nerve palsies.[18][19]

Signs

Common ocular signs in elder abuse include:

  • Periorbital ecchymosis and edema
  • Hyphema
  • Corneal or scleral lacerations
  • Cataract or lens dislocation
  • Vitreous hemorrhage
  • Retinal detachment
  • Optic nerve avulsion
  • Multilayered retinal hemorrhages including preretinal, intraretinal, and subretinal [18][19][20]
  • Signs of previous ocular surgery or trauma without adequate explanation

Symptoms

Patients may report blurred vision, visual field loss, photophobia, ocular pain, or diplopia. Neurologic symptoms such as headaches, altered mental status, or imbalance may suggest concomitant brain injury.

Clinical Diagnosis

Elder abuse with ocular manifestations is suspected when ocular findings are inconsistent with the reported mechanism of injury or when injury patterns match those known to be associated with non accidental trauma. Retinal hemorrhages are a particularly notable finding and have been reported in up to 78 percent of patients with abusive head trauma compared to those without abusive head trauma.[19][20] Findings should be correlated with systemic injuries and social context. Diagnosis is strengthened by exclusion of medical mimics such as coagulopathies and diabetic retinopathy through careful history, examination, and adjunctive testing.

Diagnostic Procedures

Prompt retinal photography is recommended when retinal hemorrhages are identified, both for medical legal documentation and to establish a baseline for follow up.[18]

Additional imaging includes:

  • Optical coherence tomography (OCT): For detailed retinal and optic nerve assessment.
  • B scan ultrasonography: Useful in cases of media opacity such as vitreous hemorrhage.
  • CT scan or MRI: Indicated when orbital fracture or intracranial injury is suspected.

In cases with possible repeated trauma, serial imaging can be valuable for demonstrating injury progression or recurrence.[18]

Laboratory Test

Targeted laboratory evaluation should be guided by the differential diagnosis and may include:

  • Complete blood count to evaluate anemia or infection [18]
  • Coagulation profile to rule out bleeding disorders [18]
  • Blood glucose and HbA1c for diabetic status [18]
  • Additional systemic workup as indicated for suspected medical mimics [18]

Differential Diagnosis

  • Blunt trauma like RTA [18]
  • Accidental head trauma due to hypoglycemia or other underlying systemic conditions [19]
  • Purtscher’s retinopathy [18]
  • Valsalva retinopathy [18]
  • Anemia [18]
  • Coagulopathy [18]

Management

Management of ocular manifestations of elder abuse aims to preserve vision, treat trauma-related injuries, and prevent long-term complications, with special focus on promptly addressing the underlying abuse to ensure patient safety.

General Treatment

Reacting to elder abuse requires a multidisciplinary and patient-centered approach that prioritizes both medical treatment and the overall safety of the individual.[21] Because of the wide variations of types of abuse, interventions vary from simple social service referral to hospital referral and even sometimes require surgical interventions.[22] Treatment should initially focus on stabilizing the general condition of the patient, then assessing for associated systemic trauma, and finally prompting a detailed ophthalmologic examination.[22] However, the social and psychological components of elder abuse must also be addressed. [6][22] If the patient is in immediate danger, the patient's protection must be prioritized.

An essential step in managing elder abuse entails reporting the abuse, even if the condition is only suspected and not yet proven.[23] This action prompts the appropriate agency, such as Adult Protective Services, to conduct further investigations and ensure the individual receives the needed help.[24] Most healthcare professionals qualify as mandatory reporters of suspected elder abuse, although specifics vary by state.[24] However, many cases of possible abuse go unreported.[12] Some reasons for not reporting abuse include concern for the loss of physician control, loss of patient trust, unintended negative consequences, the subtlety of the findings, and retaliation of perpetrators against the victim.[12] Primary care physicians appear to be subject to paradoxes of reporting that contribute to the underreporting of elder abuse.[23] These paradoxes and alternative modes of managing them are important and should be addressed in educational and training programs for physicians.[23] A systematic evaluation of these issues may help inform future legislation in this area.[23]

Medical Therapy

A detailed medical evaluation of patients suspected of being abused is necessary because medical and psychiatric conditions can mimic abuse.[25] Signs of abuse may include specific patterns of injury.[25] The evaluation should be directed by a detailed medical history and physical examination, focusing on the type of abuse suspected and injuries seen.[22] The patient’s medical history, functional capacity, mechanism of injury, examination and laboratory findings, and imaging results must be considered to find clues of potential abuse.[22]  Depending on the acuity of the presentation, hospitalization may be necessary to provide treatment and protection during further evaluation or pending legal investigation.[26] A comprehensive eye examination, including slit-lamp examination, ophthalmoscopy, and imaging, is essential to assess the extent and nature of the injury.[17] Medical treatment involves treating infections, managing pain, and addressing any corneal or retinal damage.[17] Jordan et al. addressed elder neglect due to delay in presentation, poor outpatient follow-up, and the presence of severe malnutrition.[27] The result highlighted bilateral corneal perforations as a result of elder neglect and exemplified the intersection of an acute medical presentation with a syndrome of neglect.[28]

Medical Follow-up

Regular follow-up appointments are essential to monitor and assess the effectiveness of treatment and ensure the patient's safety. Andoh et al. underscore the importance of the clinic as a point of continued interaction and support for these patients.[29] They also highlighted the need for center-level studies examining the protocol and management of domestic violence-related follow-up visits, which would help ophthalmologists to understand how to best support patients in these settings.[30] The emergency department providers should attempt to contact and coordinate with the patient’s primary care physician to ensure follow-up.[17][22] Primary care physicians and social workers are integral parts of the care team. These professionals may be able to identify nonmedical risk factors for abuse that were not initially appreciated and can help organize resources and support for the patient and family.[22] Once identified, any case should be reported to the appropriate agency, such as Adult Protective Services, to ensure the patient has proper follow-up and monitoring after going home. They should provide counseling, safety planning, and appropriate resources to the patient and caregiver, including: home health services, meal delivery, medical transportation services, assistance for setting up insurance, adult day care, senior centers, substance abuse treatment options, and respite care.[22]

Surgery

Surgical management of ocular manifestations of elder abuse focuses on addressing the specific injuries sustained, which can range from retinal detachments and lens dislocations to more severe injuries like globe rupture.[31] Common surgical procedures in this population include primary closure of open globe injuries such as corneal and scleral lacerations, vitrectomy for vitreoretinal damage, repair of traumatic cataracts, and orbital fracture reconstruction. Open globe injuries in the elderly represent a unique group. It is mostly related to falls, with a female predominance and a poor visual prognosis.[31] Open globe injuries require significant surgical follow-up. Patients requiring multiple operations tended to have worse postoperative visual acuity. Patients who underwent vitreoretinal surgery had overall worse visual outcomes.[32] Severe eye injuries are potentially devastating for vision, but vitreoretinal surgery can improve anatomical and functional outcomes.[33] Among the analysed pre- and intra-, and postoperative factors, absence of proliferative vitreoretinopathy, postoperative retinal attachment, and silicone oil as a tamponade were related to significantly improved visual acuity.[33]

Surgical Follow-up

Postoperative surgical follow-up is critical and structured at multiple intervals to monitor healing, detect complications such as glaucoma, inflammation, infection, and secondary retinal issues.[33] Each follow-up involves assessment of visual acuity, anterior and posterior segment examination, and intraocular pressure measurement. Prolonged surveillance is often necessary because complications can arise months to years after trauma. Rehabilitation interventions, including low vision support and occupational therapy, complement surgical management to optimize functional outcomes and quality of life.[33]

Complications

Elder abuse has complications for the victims, caregivers, and society as a whole.[22] For the victim, abuse has been shown to lead to physical and mental health problems, posttraumatic stress disorder, poorly controlled chronic disease, high medical bills, decreased quality of life, breakdown of trust or quality of relationships, and even premature death.[22] Physical abuse directed at the elderly can result in various traumatic eye injuries, including periorbital bruising (black eye), subconjunctival hemorrhages, corneal abrasions, lens dislocations, cataracts, retinal detachments, and orbital fractures.[34][35] These injuries often require surgical intervention and may lead to permanent visual impairment or blindness if not promptly and properly treated. Mutoh et al. reported a case of bilateral complete dislocation of lenses into the vitreous cavities due to elder abuse in a patient with senile dementia.[36] Complications may also exhibit indirect effects such as ischemic optic neuropathy or vascular occlusions resulting from systemic physical abuse or associated systemic disease exacerbation.[34] Caregivers may also suffer from the high burden of care, loss of productivity and the ability to work, and financial strain while caring for older adults.[22] Significant societal complications include the direct costs of providing care, the burden on nursing facilities, and the strain on community, legal, and law enforcement resources.[22] Early diagnosis and management of ocular complications can reduce the visual morbidity of elder abuse.

Prognosis

The prognosis for ocular manifestations of elder abuse can range from good to severe, depending on the nature and severity of ocular injury, the presence of other health conditions, and the availability of appropriate medical care.[22] Traumatic eye injuries in elder abuse, such as blunt trauma, open globe injuries, retinal detachment, and infectious complications like endophthalmitis, often lead to significant visual impairment or blindness. Elderly victims of ocular trauma, particularly serious eye injury, have worse sleep quality than subjects of the same age.[37] The prognosis depends on the severity of the injury to the eye structures, the time between the injury and surgery, the preoperative visual acuity, the mode of injury, and the patient's age. The OTS scoring system can predict the final visual acuity outcome in such cases.[38] Prognosis may worsen by many factors, including poor initial visual acuity, multiple surgeries, surgical complications, and underlying systemic conditions like hypertension and diabetes mellitus.[39] Open globe injuries tend to have worse outcomes than closed globe injuries, and injuries involving extensive ocular structural damage are associated with poor recovery despite maximal surgical repair.[40] Recognizing elder abuse and intervening promptly significantly increases morbidity and mortality, leading to heightened psychosocial distress, increased hospitalization rates, higher readmission rates, more emergency department visits, and a greater likelihood of long-term care placement.[22]

References

  1. ↑ 1.0 1.1 World Health Organization. Elder abuse. Geneva: WHO; 2020 Jun 15. Available from: https://www.who.int/en/news-room/fact-sheets/detail/elder-abuse
  2. ↑ Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World Report on Violence and Health. Chapter 5: Abuse of the elderly. Geneva: WHO Press; 2002.
  3. ↑ 3.0 3.1 3.2 Statistics Canada. Family Violence in Canada: A Statistical Profile. Section 3: Police-reported violence against seniors. Ottawa: Statistics Canada; 2009. Available from: http://www.statcan.gc.ca/pub/85-224-x/85-224-x2010000-eng.pdf
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 Lachs MS, Berkman L, Fulmer T, Horwitz RI. A prospective community-based pilot study of risk factors for the investigation of elder mistreatment. J Am Geriatr Soc. 1994;42(2):169-73. doi:10.1111/j.1532-5415.1994.tb04939.x
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Cooney C, Howard R, Lawlor B. Abuse of vulnerable people with dementia by their carers: Can we identify those most at risk? Int J Geriatr Psychiatry. 2006;21(6):564-71. doi:10.1002/gps.1525
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L, et al. Elder self-neglect and abuse and mortality risk in a community-dwelling population. JAMA. 2009;302(5):517-26. doi:10.1001/jama.2009.1109
  7. ↑ World Health Organization. Toronto Declaration on the Global Prevention of Elder Abuse. Geneva: WHO; 2002. Available from: http://www.who.int/ageing/projects/elder_abuse/alc_toronto_declaration_en.pdf
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The National Elder Mistreatment Study. Am J Public Health. 2010;100(2):292-7. doi:10.2105/AJPH.2009.163089
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 Pillemer K, Suitor JJ. Violence and violent feelings: What causes them among family caregivers? J Gerontol. 1992;47(4):S165-72. doi:10.1093/geronj/47.4.S165
  10. ↑ 10.0 10.1 10.2 10.3 Homer AC, Gilleard C. Abuse of elderly people by their carers. BMJ. 1990;301(6765):1359-62. doi:10.1136/bmj.301.6765.1359
  11. ↑ Dyer CB, Connolly MT, McFeeley P. The clinical and medical forensics of elder abuse and neglect. In: National Research Council (US) Panel to Review Risk and Prevalence of Elder Abuse and Neglect; Bonnie RJ, Wallace RB, editors. Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. Washington (DC): National Academies Press; 2003. Available from: https://www.ncbi.nlm.nih.gov/books/NBK98800/
  12. ↑ 12.0 12.1 12.2 12.3 12.4 Cooper C, Selwood A, Livingston G. The prevalence of elder abuse and neglect: A systematic review. Age Ageing. 2008;37(2):151-60. doi:10.1093/ageing/afm194
  13. ↑ 13.0 13.1 13.2 13.3 Pieramici DJ, Sternberg P Jr, Aaberg TM Sr, Bridges WZ Jr, Capone A Jr, Cardillo JA, et al. A system for classifying mechanical injuries of the eye (globe). Am J Ophthalmol. 1997;123(6):820-31. doi:10.1016/S0002-9394(14)71132-8
  14. ↑ Wilson FM. Traumatic hyphema: Pathogenesis and management. Ophthalmology. 1980;87(9):910-9. doi:10.1016/S0161-6420(80)35144-0
  15. ↑ Okoye GS, Gurnani B. Traumatic cataract. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Updated 2023 Aug 27. Available from: https://www.ncbi.nlm.nih.gov/books/NBK594251/
  16. ↑ Rosen T, Platts-Mills TF, Fulmer T. Screening for elder mistreatment in emergency departments: Current progress and recommendations for next steps. J Elder Abuse Negl. 2020;32(3):295-315. doi:10.1080/08946566.2020.1768997
  17. ↑ 17.0 17.1 17.2 17.3 Rosen T, Stern ME, Elman A, Mulcare MR. Identifying and initiating intervention for elder abuse and neglect in the emergency department. Clin Geriatr Med. 2018;34(3):435-51. doi: 10.1016/j.cger.2018.04.007
  18. ↑ 18.00 18.01 18.02 18.03 18.04 18.05 18.06 18.07 18.08 18.09 18.10 18.11 18.12 18.13 Bowling B. Kanski’s Clinical Ophthalmology: A Systematic Approach. 10th ed. Elsevier; 2024: Chapter 22, Trauma.
  19. ↑ 19.0 19.1 19.2 19.3 Simon CL, Ude I, Levin MR, Alexander JL. Retinal hemorrhages in abusive head trauma with atraumatic neuroimaging. J AAPOS. 2023;27(1):39-42. doi:10.1016/j.jaapos.2022.10.005.
  20. ↑ 20.0 20.1 Maguire SA, Watts PO, Shaw AD, et al. Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review. Eye (Lond). 2013;27(1):28-36. doi:10.1038/eye.2012.213.
  21. ↑ Clarke ME, Pierson W: MANAGEMENT OF ELDER ABUSE IN THE EMERGENCY DEPARTMENT. Emergency Medicine Clinics of North America. 1999, 17:631–44. 10.1016/S0733-8627(05)70087-0
  22. ↑ 22.00 22.01 22.02 22.03 22.04 22.05 22.06 22.07 22.08 22.09 22.10 22.11 22.12 22.13 Jandu JS, Mohanaselvan A, Johnson MJ, Fertel H: Elder Abuse. In: StatPearls. StatPearls Publishing: Treasure Island (FL); 2025.
  23. ↑ 23.0 23.1 23.2 23.3 Rodríguez MA, Wallace SP, Woolf NH, Mangione CM: Mandatory Reporting of Elder Abuse: Between a Rock and a Hard Place. The Annals of Family Medicine. 2006, 4:403–9. 10.1370/afm.575
  24. ↑ 24.0 24.1 Henriksen E, Rosenqvist U: Contradictions in elderly care: a descriptive study of politicians’ and managers’ understanding of elderly care. Health Soc Care Community. 2003, 11:27–35. 10.1046/j.1365-2524.2003.00403.x
  25. ↑ 25.0 25.1 Hoover RM, Polson M: Detecting Elder Abuse and Neglect: Assessment and Intervention. afp. 2014, 89:453–60.
  26. ↑ Dong X, Simon MA: Elder abuse as a risk factor for hospitalization in older persons. JAMA Intern Med. 2013, 173:911–7. 10.1001/jamainternmed.2013.238
  27. ↑ Jordan J, Selman K, Byrne R: Bilateral Corneal Perforations Due to Elder Neglect. Journal of Geriatric Emergency Medicine. 2024, 5:. 10.17294/2694-4715.1076
  28. ↑ Jordan J, Selman K, Byrne R: Bilateral Corneal Perforations Due to Elder Neglect. Journal of Geriatric Emergency Medicine. 2024, 5:. 10.17294/2694-4715.1076
  29. ↑ Andoh JE, Mehta SK, Mir TA, Chen EM, Nwanyanwu K, Teng CC: Domestic violence-related ocular injuries among adult patients: data from the nationwide emergency department sample, 2008–2017. Ophthalmic Epidemiol. 2024, 31:169–77. 10.1080/09286586.2023.2222792
  30. ↑ Andoh JE, Mehta SK, Mir TA, Chen EM, Nwanyanwu K, Teng CC: Domestic violence-related ocular injuries among adult patients: data from the nationwide emergency department sample, 2008–2017. Ophthalmic Epidemiol. 2024, 31:169–77. 10.1080/09286586.2023.2222792
  31. ↑ 31.0 31.1 Vidne-Hay O, Fogel Levin M, Luski S, Moisseiev J, Moisseiev E: Blunt ocular trauma in patients over 70: Clinical characteristics and prognosis. European Journal of Ophthalmology. 2021, 31:2705–9. 10.1177/1120672120946579
  32. ↑ Andreoli MT, Andreoli CM: Surgical rehabilitation of the open globe injury patient. Am J Ophthalmol. 2012, 153:856–60. 10.1016/j.ajo.2011.10.013
  33. ↑ 33.0 33.1 33.2 33.3 Nowomiejska K, Choragiewicz T, Borowicz D, et al.: Surgical Management of Traumatic Retinal Detachment with Primary Vitrectomy in Adult Patients. J Ophthalmol. 2017, 2017:5084319. 10.1155/2017/5084319
  34. ↑ 34.0 34.1 van Houten ME, Vloet LCM, Pelgrim T, Reijnders UJL, Berben SAA: Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review. Eur Geriatr Med. 2022, 13:53–85. 10.1007/s41999-021-00550-z
  35. ↑ Identifying and responding to child and elder abuse. Optometry Times. (2018). Accessed: August 13, 2025.
  36. ↑ Mutoh T, Tien T, Horie M, Matsumoto Y, Chikuda M: Case of bilateral complete posterior dislocation of lens caused by elder abuse. Clin Ophthalmol. 2012, 6:261–3. 10.2147/OPTH.S28990
  37. ↑ Moreira SHN, Kasahara N: Patterns of Ocular Trauma among the Elderly in a South-American Urban Area and the Association between Eye Traumas with Sleep Disorders. J Emerg Trauma Shock. 2017, 10:111–5. 10.4103/JETS.JETS_90_16
  38. ↑ Martyana dr DE, Kusumastuti DH: Management of Open Globe Injury Followed by Cataract Traumatic and Corneal Laceration in a 37-year-old Man. A Case Report: Poster Presentation - Case Report - General practitioner. Ophthalmologica Indonesiana. 2023, 49:. 10.35749/nexrwy13
  39. ↑ Pham VQ, Miller HM, Fernandez EO, Marchi D de, Zhu H, Fleischman D: The Association of Cardiovascular and Neurological Comorbidities in Geriatric Patients Sustaining Ocular Trauma. OPTH. 2023, 17:3409–17. 10.2147/OPTH.S434804
  40. ↑ Lu S, Li H, Yang X, Ma C, Li X: Epidemiology of Ocular Trauma and Predictive Modeling of Visual Outcomes: A 12-Year Retrospective Study at a Tertiary Hospital in China. RMHP. 2025, 18:691–702. 10.2147/RMHP.S505657
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