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Postmortem interval, the time elapsed since the death of a body, is critical in determining the investigations of unwitnessed deaths. Therefore, it is a fundamental variable that has been investigated for numerous years. The eye is one of the readiest organs to assess; thus, it becomes very convenient when analyzing a corpse at a crime scene. Several cadaveric phenomena have been described in the eyes, which can be observed in different structures such as the cornea, sclera, iris, lens, vitreous body, retina, and intraocular pressure. These phenomena can, directly and indirectly, contribute to determining the postmortem interval, and so have other quantitative and reproducible elements that collaborate in investigating deaths without witnesses, including deaths in hospitals or at home, and with this to be able to resolve trials. Consequently, in the next chapter, we will review the elements necessary to determine postmortem interval, considering cadaveric phenomena occurring at an ocular level.
School of Medicine, Autonomous University of San Luis Potosí, México, San Luis Potosí, México
Cesar Hernandez Mier
Law School “Abogado Ponciano Arriaga Leija”, Autonomous University of San Luis Potosí, México, San Luis Potosí, México
*Address all correspondence to: vianneyrmzojeda@gmail.com
1. Introduction
The emergence of forensic sciences is born out of the law’s necessity of answering questions, which, although they originate within the law, have found a basis in other sciences. Therefore, throughout history, the law has incorporated sciences that have contributed to answering those questions that the law raises to solve the problems it addresses. Such a set of sciences is known as the forensic sciences.
Likewise, it is essential to highlight that a large number of questions for which the law demands an answer have a basis in time; that is, they are questions that seek to know elements associated with time, for example, the date of a laceration, the age of an individual, the time it takes for lacerations to heal, and even the date of death.
These types of questions are not new. We can say that, since the dawn of law, humans have attempted to solve one of the crucial questions associated with time: when did a given person lose their life? We have tried to implement procedures such as qualitatively describing cadaveric phenomena, determining metabolites, and other more sophisticated methods.
However, the evolution of science and so-called evidence-based medicine has led to questioning many of these procedures that were considered valid until a few years ago. Therefore, we have conducted actions that allow quantitative parameters with narrow and known margin errors to determine postmortem interval. For this reason, this chapter reviews the methods for estimating the postmortem interval from ocular parameters.
Indeed, one of the main objectives during the practice of a necropsy is determining the moment in which a person dies, understood as the period that elapses from the moment a person loses his life to the moment the body is found, or an expert practices an intervention. Consequently, its importance is such that, in some cases, it could determine the responsibility, or lack thereof, of a person in the death of an individual.
The commonly used term in medical forensics is estimated postmortem interval (PMI); however, postmortem window is the term of choice in some places. Its usefulness lies not only in estimating how long a body has been dead but in distinguishing antemortem from postmortem trauma. Thus, in most homicide cases or unwitnessed death investigations (including in-hospital deaths), it is a crucial step since it is essential to include and exclude suspects. Therefore, it remains one of the most critical, and challenging to quantify and establish, variables despite widely conducted research [1, 2].
Techniques currently used to estimate PMI are very diverse. Most have focused on the qualitative analysis of cadaveric phenomena (Table 1), which we can define as traces left by death. Their study contributes to estimating PMI. Among the critical phenomena classified as abiotic are cadaveric lividity [4], often described as one of the first signs of death; cadaveric rigidity or rigor mortis [5]; thermal exchange with the environment; and dehydration process. The latter is caused by the evaporation of body fluids and is observed mainly in body weight, skin, mucous membranes, and at an ocular level [6, 7].
1. Methods Based on Temperature Measurement
2. Other Methods
a. Supravitality Phenomena
i. Ocular Changes
ii. Mechanical Excitability
iii. Electric Excitability
b. Changes in Muscles and Tissue
i. Cadaveric Rigidity
ii. Hypostasis
c. Assessment of Gastric Content
d. Tanathochemical Methods
Table 1.
Classification of methods of estimating early postmortem interval [3].
It is precisely the cadaveric phenomenon (CF) of dehydration, specifically the process of dehydration at an ocular level, that we will be addressing in this work, which is why it is essential to analyze some basic principles of ocular anatomy.
Although critical elements can be collected from the examination of the eyes of a cadaver, the latter are not routinely subjected to in-depth analysis since ocular pathology is an important challenge for non-specialist physicians in the area. So, before delving into ocular cadaveric phenomena, it is of the essence to acquire basic ocular anatomy knowledge and the nomenclature used by ophthalmologists to describe injuries, pathologies, and ocular phenomena. This knowledge will improve doctor-examiner communications. For a better anatomical description of the eyeball and its annexes, we will describe it from the outside along an axial plane (Figure 1).
Eyelids: They are the outermost and protective structure of the eyeball, they are composed of the thinnest skin of the human body, the orbicularis oculi muscle in its preseptal and pretarsal portion, and the tarsus (a cartilaginous structure that contains the glands of meibomian), in the upper eyelid is the levator muscle of the eyelid, which as its name suggests, helps to raise the eyelid and the eyelid opening [9, 10].
Orbit: It is a rigid pear-shaped cavity that protects the structures of the eyeball and comprises four bone walls: superior, inferior, lateral, and medial walls [9].
Conjunctiva: A transparent mucous membrane that covers the inner surface of the eyelids and the anterior surface of the eyeball, ends at the corneoscleral limbus, and has abundant vascularization from the anterior and palpebral ciliary arteries. Its function is mainly protective, intervening in passive and active immunity [9, 10].
Cornea: It is a complex and transparent structure composed of five layers (from anterior to posterior): epithelium, Bowman’s layer (a membrane that limits and protects internal tissues), stroma, Descemet’s membrane, and endothelium. In addition to fulfilling a protective mission, it is responsible for three-fourths of the eye’s optical power. It lacks blood vessels, but it is the body tissue with the highest nerve density. Moreover, it nourishes itself through the aqueous humor in the anterior chamber. Its thickness averages 500 microns, but it is a strong and stable fabric [9].
Anterior chamber: The space between the iris and the cornea contains aqueous humor, a transparent liquid produced by the ciliary processes that nourish the cornea [9, 10].
Iris: It constitutes a muscular membranous tissue that functions as a diaphragm inside the eye. The central opening, the pupil, can vary its diameter: miosis (constriction) occurs to reduce light entry; and mydriasis, to increase light entry.
Sclera: The scleral stroma is composed of collagen bundles of various sizes and shapes that are not oriented uniformly with the cornea, so it is not transparent but white; the inner layer of the sclera fuses with the uvea. It also provides rigidity and support to the eyeball [9, 10].
Vitreous: It is a transparent extracellular gel formed by collagen, soluble proteins, hyaluronic acid, and water. Its total volume is approximately 4 mL, it provides structural support to the eyeball and at the same time, it is a transparent and optically uniform medium for light to reach the retina.
Retina: It is the inner layer of the eye that is responsible for transmitting nervous and visual stimuli to the optic nerve, it also contains the macula, a structure of the posterior pole, located within the temporal vascular arcades and provides the central vision of the eye [10].
Figure 1.
Diagrammatic representation of the gross anatomy of the globe [8].
At an ocular level, different indicators can help determine the circumstances or events the corpse could have gone through, pre- and post-mortem. These can occur in all the structures forming the eyeball and its previously described annexes.
4.1 The importance of evaluating ocular trauma
Postmortem ocular findings can be instrumental in estimating postmortem interval. We must first determine and assess the integrity of ocular structures and their annexes in a given corpse. Since such trauma is a frequent occurrence in physical aggressions, work incidents, and traffic accidents—the leading causes of unwitnessed deaths—conducting an initial assessment to decide whether or not the integrity of the eyeball will help determine the postmortem interval.
Injuries to be assessed are listed according to the affected anatomical area:
Eyelids: Possible injuries in the eyelids include lacerations (continuity solution) Figure 2A, palpebral ecchymosis, and palpebral edema. If any of these three is present, a complete evaluation will be necessary to rule out rupture or laceration to the eyeball [11].
Cornea: It will be necessary to open the eyelids to assess the integrity of the cornea and determine if there are abrasions, corneal erosions, or corneal opacity (which may be related to chemical burns), or corneal foreign bodies (Figure 2B). This assessment is essential because it can completely change the cadaveric phenomena after death; pathologies may cause opacity before death, such as absolute glaucoma, corneal hydrops, corneal transplant rejection, corneal ulcers, or scars. In addition, when there are full-thickness corneal injuries, intraocular pressure can decrease significantly, and on the contrary, when there is hyphema or traumatic uveitis, (Figure 2C–D) intraocular pressure might increase. In such situations, we shall not consider the pressure measurement as a determining factor of postmortem interval [10].
Conjunctiva: As previously described, this is a significantly irrigated layer. In traumatic situations, subconjunctival hemorrhages (hyposphagma) or hemorrhagic chemosis are infrequent; in the case of the latter, it must rule out rupture of the eyeball.
Anterior chamber: A complete evaluation of the iris, beginning with the pupils, can give significant clues. Spastic miosis is frequently associated with ocular trauma and is generally transient. In contrast, mydriasis may be associated with rupture of the pupillary sphincter or traumatic uveitis, which can modify intraocular pressure and the characteristics of the ocular postmortem process. Hyphema (blood deposited in the anterior chamber) can also cause increased intraocular pressure and modify this parameter as a postmortem indicator.
Lens: Traumatic cataract formation following direct trauma to the eyeball can cause complete opacification of the lens.
Vitreous: At the vitreous level, it will be necessary to assess its transparency because there could be a hemorrhage in the vitreous cavity after a trauma (hemovitreous) which would prevent us from assessing the retina and retinal cadaveric phenomena.
Retina: Ocular trauma—from retinal contusion, retinal dialysis, and retinal detachment to choroidal detachment—may seem unclear at first sight. The latter can change the external assessment of the eyeball, causing ocular hypotonia.
Orbit: At the orbital level, ethmoid and orbital floor fractures are common in ocular trauma and are usually associated with signs related to other ocular structures [11].
Figure 2.
Ocular traumatisms that can modify ocular cadaveric phenomena. A.- Eyelid laceration. B. Full-thickness corneal laceration with iris protrusion. C.- Vossius ring secondary to swelling in anterior chamber (traumatic uveitis) D.- Hyphema (blood in anterior chamber).
The above shows that before considering cadaveric phenomena at the ocular level, we must rule out the existence of ocular trauma since this will substantially modify the interpretation of the ocular cadaveric phenomenon.
The determination of postmortem interval is a crucial parameter in medicolegal cases and unwitnessed deaths. One of the most convenient anatomical sites in forensic investigations is the eyes because it is an easily accessible area for analysis. Therefore, a complete initial assessment of the eyeball and its annexes will have to be exhaustive so that the eyes can provide the necessary information regarding the time of death.
5.1 Loss of corneal transparency or corneal opacity
As previously mentioned, the corneal structure is a translucent tissue. However, as the date of death evolves, it begins to opacify, caused by the deposit of remnants of softened and detached corneal epithelium. This phenomenon is relatively early. Still, it is the beginning of a sequence of events like those described by Nori in 2018, which we can see in Table 2 [12, 13].
Hours post-mortem
Main findings at OCT analysis
<2
Decrease in corneal thickness
Increase in epithelial reflectivity
2–6
Increase in thickness of corneal stroma
Increase in endothelial reflectivity
Visible differentiation in reflectivity between the anterior and posterior stromal segments
6–12
Corneal swelling
Delamination of the stroma
12–24
Decrease in depth of anterior chamber
Disappearance of the epithelium
Formation of hypo-reflective areas
24–48
Decrease in depth of anterior chamber
Decrease in corneal curvature
Disappearance of the epithelium
48–72
Iris and cornea tended to collapse
Posterior stroma tended to vacuolise
Formation of subepithelial bubbles
Formation of hyper-reflective dots (debris) in the aqueous humor
Table 2.
Main findings in the cornea according to the postmortem hours described by Nioi et al. [12].
The association between the loss of corneal transparency with the time elapsed since death was established in 1965 by Aoki et al., who reported that the cornea remained transparent for 8 to 12 postmortem hours. However, signs of opacity became evident in 15% of cases between 12 and 18 postmortem hours, 25% of cases between 18 and 24 postmortem hours, and 75% of cases between 24 and 36 postmortem hours [14]. In 1970, Wroblewski and Ellis reported that minimal corneal opacity was visible at two postmortem hours in 74% of cases, thus concluding that the total absence of this phenomenon indicates that death occurred within the two previous hours [15].
We must analyze this information critically must be analyzed while highlighting its limitations. On the one hand, corneal opacity is a qualitative variable at this time, so it is subject to the observer’s appreciation and the conditions in which the observation was conducted. In turn, it may be affected depending if the eyes were kept closed or open after death. Weather variations affect it directly; even humidity and extreme heat can generate early corneal opacity.
5.2 Changes in pupil diameter
After death, the photomotor reflex (pupillary constriction produced by light) cannot be stimulated, so pupils usually present median mydriasis. Pharmacological agents such as acetylcholine and tropicamide do not affect this phenomenon; therefore, we should consider using changes in pupil size to estimate the postmortem interval with great caution; we must remember that, if there was ocular trauma, the rupture in the iris sphincter could change this assessment [16].
We may describe it as a black spot with poorly defined contours that appears on the outer side of the eyeball, emerging posteriorly. The spot tends to spread transversely and is not an absolute constant; it is caused by desiccation of the sclera, which produces its thinning, allowing the observation of the uveal tissue (choroid) [17]. As similarly referred to in corneal opacity, this is a qualitative variable. Thus, it is subject to the appreciation of the observer and the conditions in which the observation is made. Conversely, it can be affected by whether the eyes were kept closed or opened after death and directly by weather conditions.
6.1 At the posterior segment level (Retinal changes)
The assessment of the eye fundus, even in living people, is mainly subjective. Thus, changes seen after death are relatively complex for a forensic pathologist to assess. These have been described since 1920 by Würdermann as an opaque and folded membrane due to retinal infiltration and disorganization, which subsequently stains gray mainly around the optic nerve and the macula; 10–12 hours after death, observing this phenomenon more frequently in young cadavers. Toru Oshima et al. observed the appearance of the retinal fold in 63.3% of corpses, also observed on ocular ultrasound [18]. Death in the prone position was not associated with a postmortem retinal fold, unlike death in the prone position. Although it is a complicated phenomenon to observe and has some limitations, it is difficult to distinguish between postmortem retinal folds and antemortem retinal detachment. The other limitation is corneal opacity which makes it impossible to perform adequate ophthalmoscopy r two hours after death. That is when the cornea begins to cloud. Ocular ultrasonography can be used for noninvasive imaging of postmortem vitreoretinal adhesions [18].
Another phenomenon observed in the retina is the fibrin bridges in the retinal vessels, this segmentation begins 10–15 minutes after death, and in the first three hours, it can be stimulated by rotating the head or exerting pressure on the eyeballs or the thorax.
6.2 Decrease in intraocular pressure
Normal intraocular pressure is mainly determined by aqueous humor: the fluid that fills the anterior and posterior chambers of the eye. Average values range between 10 and 20 mmHg [19]. Some authors have concluded that there is an inverse relationship between the decrease in postmortem intraocular pressure and the time elapsed from death. The longer the postmortem interval, the lower the intraocular pressure, presenting a linear drop over time, at a rate of approximately two mmHg per hour, so it can be a helpful indicator in estimating the early postmortem interval [20].
Measuring intraocular pressure by applanation tonometry is a simple, fast, cheap, and easy method to perform. Although, for now, it cannot accurately determine the time of death of a corpse due to the number of modifying variables, it can be helpful as an additional element to the other cadaveric phenomena for the determination of the postmortem interval, thus having another quantitative and reproducible element that collaborates in the investigation of unwitnessed deaths.
6.3 Sunken eyes
As previously mentioned, eyeball turgidity is the result of keeping intraocular pressure, and pressure, in turn, is caused by intraocular fluids. Therefore, the evaporation of intraocular fluids produces a decrease in intraocular pressure, which is a sign late and persistent. This process has been associated as a factor that generates corneal striae, these being one more sign at the ocular level [18].
6.4 New ocular evaluations in postmortem interval estimation
As technology has progressed, medical science has acquired new methods to increase precision and quantitatively measure changes related to the postmortem interval, such as optical coherence tomography image analysis of the cornea and posterior segment, biometrical analysis of the iris, and histological analysis.
It is a relatively complex technique. In 2013, Kaliszan used a high-precision thermometer, with which he inserted a probe in the posterior chamber (vitreous) and another in the rectum to make a comparison [21]. Results showed that it is an excellent method for estimating an early postmortem interval. However, it has several limitations, such as the cadaver’s changes according to the environmental temperature and humidity, in addition to the complexity of the measurement technique.
This method is not new; there have been studies since 1989 reporting on metabolic changes in the vitreous. This approach was used because the vitreous humor is easy to collect and resistant to deterioration, contamination, and bacterial degradation [22]. To determine metabolites, we must perform a direct aspiration of the eyeball and run an analysis in a specialized laboratory. Metabolites that can be used are sodium, chlorine, calcium, and urea nitrogen. However, one of the primary studied metabolites is potassium, for which a linear concentration relationship, increasing with time after death, of approximately 0.203 mmol per hour has been determined [23]. Vitreous urea nitrogen is also a stable postmortem parameter. It provides information on the homeostasis of electrolyte metabolism. However, these values can be affected by various factors such as environmental temperature, electrolyte imbalances at the time of death, and previous alcohol consumption to death. The standard deviation in various studies is significant [24].
It has been recently described that the lens can change after death. A statistically significant reduction in both absorbance and sphericity has been found, as well as gradual decomposition of the structure and organization of the lens components. The results were corroborated by histologic examination and digital images produced within 96 hours of death [25]. It should be noted that it is a very specialized method, and there is still no research on humans.
OCT is an imaging technique based on low coherence interferometry. It allows noncontact tissue to be studied three-dimensionally and in real time. Portable OCT allowed Matteo Nioi et al. to evaluate morphometric changes in the postmortem period’s cornea, sclera, and vitreous humor.
In the cornea, studies have found a progressive tendency towards tissue thickening and the progressive formation of waves in the endothelial tissue layer, with increased endothelial reflectivity (Nioi-Napoli sign). Nonetheless, cornea thickness is greatly influenced by factors such as eyelid opening because when the eyes remain open, a rapid reduction in thickness is observed within the first few hours, whereas, when they are closed, this parameter increases progressively [8].
Researchers have also observed a decreased amplitude of the anterior chamber and changes in the iridocorneal angle, corneal edema 6 hours after death, and total loss of corneal epithelium 36 hours after death [8].
OCT changes in the sclera were characterized by hyperreflectivity of the outer layer with physical separation between the sclera and choroids, although studies to determine this phenomenon are still lacking. In the retina, analysis was limited due to pupil size and media opacity (lens and cornea), as previously described.
11. Conclusions
Developing a reliable and easily replicable method for estimating the time since death remains one of forensic medicine’s most significant and oldest challenges—the limitations for the practical and daily use of these methods of the essence. Mathematical issues have limited parameters, such as postmortem pupillary diameter and eyeball temperature variations. In contrast, required subjective descriptions mainly limit variations in parameters such as corneal transparency and retinal changes. Regarding lens alterations, they are currently not approved for forensic use, and their evaluation is also highly invasive. The use of computational models is currently limited by the lack of solid data necessary to produce a reliable model; however, the inclusion of ocular phenomena can be helpful as an additional element to the other cadaveric phenomena for determining postmortem interval, thus having quantitative and reproducible elements. Furthermore, eyes are an ideal data source to estimate postmortem interval because of their ease of reach, and some components can be highly predictable. We cannot deny that the enormous and persistent effort to find a solution to this problem has contributed to a better understanding of the macroscopic, microscopic, and molecular changes after death.
References
1.Meurs J, Krap T, Duijst W. Evaluation of postmortem biochemical markers: Completeness of data and assessment of implication in the field. Science & Justice. 2019;59(2):177-180. DOI: 10.1016/j.scijus.2018.09.002
2.Riaz Q , Anwar H, Rizwan H, Phil M. Medico legal importance of post-mortem interval. (An autopsy based study). Ophtalmology. 2016;4:92-104
3.Rafael M. Bañón González y Juan Pedro Hernández del Rincón. “Determinación de la data en el periodo precoz de la muerte. Métodos instrumentals”. Revista Española de Medicina Legal. 2010;36(2):83-86
4.Milroy CM. Forensic taphonomy: The postmortem fate of human remains. BMJ. 1999;319(7207):458
5.Lundquist F, Curry AS. Methods of Forensic Science. Vol. 42. London, New York: Interscience Publishers (ed); 1963. pp. 356-367
6.Swann LM, Forbes SL, Lewis SW. Analytical separations of mammalian decomposition products for forensic science. Analytica Chimica Acta. 2010;682(1-2):9-22
7.Gisbert C. Medicina Legal y Toxicología. Barcelona: Elsevier; 1998. pp. 191-194
8.Malthotra A, Minja FJ, Crum A, Burrowes D. Ocular anatomy and ross-sectional imaging of the eye. Seminars in Ultrasound, CT, and MR. 2011;32(1):2-13
9.Kanski J. Oftalmología Clínica. 9th ed. Glaucoma: Harcourt (ed). pp. 229-203
10.Moreno C, Fagundez V. Traumatismos oculares: Aspectos médico-legales. Cuadernos de Medicina Forense. 2012;29:5-19
11.Nioi M, Napoli PM, Demontis R, Locci E, Fossarello M, D’Aloja E. Postmortem ocular findings in the optical coherence tomography era: A proof of concept study based on six forensic cases. Diagnostics (Basel). 2021;11(3):413
12.De-Giorgio F, Grassi S, d’Aloja E, Pascali VL. Post-mortem ocular changes and time since death: Scoping review and future perspective. Legal Medicine (Tokyo, Japan). 2021;50:101862
13.Jaafar S, Nokes LD. Examination of the eye as a means to determine the early postmortem period: A review of the literature. Forensic Science International. 1994;64(2-3):185-189
14.Wroblewski BM. Estimation of time of death by eye changes. Forensic Science. 1973;2(2):201-205
15.Koehler K, Sehner S, Riemer M, Gehl A, Raupach T, Anders S. Post-mortem chemical excitability of the iris should not be used for forensic death time diagnosis. International Journal of Legal Medicine. 2018;132(6):1693-1697
16.Wilson A, Serafin S, Seckiner D, Berry R, Mallett X. Evaluating the utility of time-lapse imaging in the estimation of postmortem interval: An Australian case study. Forensic Science International: Synergy. 2019;1:204-210
17.Oshima T, Yoshikawa H, Ohtani M, Mimasaka S. Examination of postmortem retinal folds: A non-invasive study. Journal of Forensic and Legal Medicine. 2015;30:16-20
18.Lanza M, Laccarino S, Mele L, Carnevale UA, Irregolare C, Lanza A, et al. Intraocular pressure evaluation in healthy eyes and diseased ones using contact and non contact devices. Contact Lens & Anterior Eye. 2016;39(2):154-159
19.Ramírez S, Rangel M, Mier C. Tonometria ocular en pacientes críticos y su comportamiento. Revista Española de Medicina Legal. 2020;3:329-336
20.Kaliszan M. Studies on time of death estimation in the early post mortem period – application of a method based on eyeball temperature measurement to human bodies. Legal Medicine (Tokyo, Japan). 2013;15(5):278-282
21.Coe JI. Vitreous potassium as a measure of the postmortem interval: An historical review and critical evaluation. Forensic Science International. 1989;42(3):201-213
22.Lange N, Swearer S, Sturner WQ. Human postmortem interval estimation from vitreous potassium: An analysis of original data from six different studies. Forensic Science International. 1994;66(3):159-174
23.Ekaterina A, Zelentsova LV, Yanshole OA, Snytnikova VV, et al. Post-mortem changes in the metabolomic compositions of rabbit blood, aqueous and vitreous humors. Metabolomics. 2016;12:172
24.Prieto-Bonete G, Perez-Carceles MD, Luna A. Morphological and histological changes in eye lens: Possible application for estimating postmortem interval. Legal Medicine (Tokyo, Japan). 2015;17(6):437-442
25.Napoli PE, Nioi M, Gabiati L, Laurenzo M, De-Giorgio F, Scorcia V, et al. Repeatability and reproducibility of post-mortem central corneal thickness measurements using a portable optical coherence tomography system in humans: A prospective multicenter study. Scientific Reports. 2020;10(1):14508
Written By
Sandra Vianney Ramírez Ojeda and Cesar Hernandez Mier
Submitted: 23 July 2022Reviewed: 24 August 2022Published: 15 May 2024
Open access peer-reviewed chapter
