To the Editor.—
The review by Grin et al1 on eye injuries in children reported the frequency and causes of serious ocular trauma in children. We recently had a patient with bilateral ecchymosis of the eyes due to a Valsalva effect that might have been confused with trauma or child abuse. This 11-year-old boy had had two previous urologic procedures to relieve a urethral stricture. During a 2-week period, he noted increased difficulty voiding and was observed by his parents to strain frequently to urinate.