Retinal haemorrhage in abusive head trauma


  • Supported in part by The Foerderer Fund.

Dr Alex V Levin, Pediatric Ophthalmology and Ocular Genetics, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107-5109, USA. Email:


Paediatric abusive head injury may have grave consequences, especially when characterized by repetitive acceleration–deceleration forces (shaken baby syndrome). Death occurs in approximately 30% and permanent neurologic damage in up to 80% of the victims. Retinal haemorrhages are a cardinal sign seen in approximately 85% of cases. In most cases haemorrhages are preretinal, intraretinal and subretinal, too numerous to count, and involving the entire retinal surface extending to the ora serrata. Traumatic macular retinoschisis is a lesion with important diagnostic significance. Vitreoretinal traction appears to be the mechanism of haemorrhage and schisis formation along with a possible role of orbital tissue trauma from repetitive acceleration–deceleration forces. Ophthalmologists must carefully document ocular findings. Appropriate autopsy examination should include ocular and orbital tissue removal. Although there is a wide differential diagnosis for retinal haemorrhages, clinical appearance, when considered in the context of systemic and laboratory findings, usually leads to the correct diagnosis.