To the Editor.
—In discussing the pathologic changes in eyes of children who died after suspected child abuse, Elner et al1 asserted "that such trauma may be repeated is indicated by positive stains for hemosiderin"; this statement provides an opportunity for medicolegal confusion and miscarriage of justice. According to one source,2 hemosiderin, a breakdown product of hemoglobin from red blood cells, may be identified as early as 1 day after injury, although other authors3 are fairly circumspect and suggest that an interval of "several days" must pass before hemosiderin is deposited; macrophages that assemble ferritin into hemosiderin are identified at injury sites within 48 to 72 hours.Certainly, the detection of hemosiderin may indicate repeated trauma, but hemosiderin may also be a marker of survival after one episode of trauma. A child may be traumatized once and survive long enough for hemoglobin to be metabolized into hemosiderin.
Gilliland MGF, Luckenbach MW, Massicotte SJ, Folberg R. The Medicolegal Implications of Detecting Hemosiderin in the Eyes of Children Who Are Suspected of Being Abused. Arch Ophthalmol. 1991;109(3):321-322. doi:10.1001/archopht.1991.01080030023019