AOA 2025: Collaborative approaches to recognizing and addressing domestic violence

In domestic violence cases, if there is physical abuse, there will be a related injury that’s involving the head, face, or eyes.

When a disheveled woman first sat before Kristin Adams, OD, the optometrist was unsure whether she would see her again. Wiping tears from her face, hands damaged from past instances of physical trauma, the patient confided in Adams that she was a survivor of domestic violence. Adams swiftly referred her to the office next door to Colleen Onstad, MSW, LICSW, for access to social services. Onstad scheduled an appointment for the patient for the following morning.

“Lo and behold, she came. She was my 9 o’clock patient,” Onstad said.

Adams said she later saw her in the hallways of Hennepin Healthcare’s Traumatic Brain Injury Outpatient Program in Minneapolis, Minnesota, smiling, wearing makeup, sporting new clothing, and feeling confident.¹ “She’d always smile and wave at me about how happy she was that I took the time to listen to her, and she [told] me and my technician how we changed her life,” Adams said.

Adams and Onstad detailed the patient's story during their presentation titled “Collaborative Approaches to Recognizing and Addressing Domestic Violence: The Role of Optometrists and Social Workers” during Optometry’s Meeting 2025 in late June as a testament to the importance of recognizing the signs of domestic violence in patients. Adams said that traumatic brain injuries (TBIs) can be a common indicator of a domestic violence case, as 10% of TBI-related visits to the emergency department are from assaults, including domestic violence. Physical symptoms include headaches, dizziness and balance problems, blurred or double vision, cranial nerve palsies, sensitivity to light and noise, and cognitive issues.¹

Adams stated that most of the time in domestic violence cases, if there is physical abuse, there will be a related injury that involves the head, face, or eyes, leading to visual and ocular symptoms.¹

Women are particularly at risk of experiencing TBIs as a result of domestic violence, sustaining 11 to 12 times more TBIs than all TBIs in the military and athletes, male and female, combined. Additionally, 75% of women who have domestic violence-related TBIs also experienced childhood abuse.¹

“Since they were raised in a violent home, they probably also suffered head injuries early in life,” Adams said. They have these chronic head injuries throughout their life, which also highlights the point where this can be intergenerational, a cycle of violence and trauma. So we as optometrists can try and help break the cycle and help prevent more abuse happening and prevent further generations from being harmed, because as children we’re going to learn what we live and repeat those things as well.”

Additionally, only 34% of domestic violence survivors seek medical care, which may leave optometrists as one of the only medical providers survivors will visit. One survey found that only 7% of women who were injured in domestic violence cases reported that their health care provider specifically asked whether they were experiencing domestic violence.¹

“Traumatic brain injury is called a silent epidemic because it’s like an iceberg,” Adams said. “We can see just a tip of the problems that patients are having. There’s so much below the surface that you don’t notice.”

Physical signs to look for during examinations are injury patterns – or bruises in various healing stages – defensive fractures in the forearms, repeated injuries in the same areas, bite marks, burns, linear or circular bruises, and hoarseness in the voice and petechiae on the face or eyes due to strangulation. Other common head and ocular injuries caused by domestic violence include zygomaticomaxillary complex fractures, orbital fractures, periorbital contusions or lacerations, and subconjunctival hemorrhages.¹ “We could be looking at anything from a corneal abrasion all the way to a retinal detachment,” Adams said. “No part of the eye is going to be immune from violence.”

Adams said a patient dressing inappropriately for the weather – such as a turtleneck on a hot summer day – can be an indicator that they are hiding an injury. Additionally, patients who come in often with broken glasses or need adjustments could indicate that they are receiving physical abuse to the face and head.¹

“We also want to talk about the inconsistent or the minimization of explanations of why they’re being hurt,” Adams said. “They might have variable stories. They might tell the technician one thing, they might tell you another.” She also noted that an electronic health record available to the entire practice or hospital system can help verify differentiation in a story between providers.¹

She said that speaking privately with a patient one-on-one and using empathetic language is the best way to address concerns of domestic violence. Verbal consent must be obtained before making a referral to a social worker, according to Adams. Making these referrals can be made easier by reaching out and building relationships with nearby resources such as local shelters, social service agencies, nearby hospitals and health care systems, and primary care providers.¹

Reference:

1. Adams K, Onstad C. Collaborative Approaches to Recognizing and Addressing Domestic Violence: The Role of Optometrists and Social Workers. Presented at: Optometry’s Meeting 2025; June 25-28; Minneapolis, MN.