Differential diagnosis of retinal haemorrhages

A systematic review examined non-traumatic causes of retinal haemorrhage in children who also have one or more other features known to be associated with child abuse (bruising, fractures, intracranial haemorrhage).[1] Nine conditions were identified: glutaric aciduria, methylmalonic aciduria with homocysteinuria, osteogenesis imperfecta, platelet function defects, protein C deficiency, low fibrinogen levels, haemorrhagic disease of the newborn, fibromuscular dysplasia and spinal cord arteriovenous malformation. Most cases with one of the above medical conditions, where the eye review was completely documented, recorded either unilateral or bilateral retinal haemorrhages, but only located in the posterior pole. One case review of a child with fibromuscular dysplasia recorded retinal haemorrhages that were extensive and widespread.


The review also looked at confounding conditions that could potentially cause retinal haemorrhages. No children with a cough or acute life-threatening event were found to have retinal haemorrhages. Two out of 217 children with seizures and normal clotting studies had retinal haemorrhages in the posterior pole. One child out of 43 who received cardiopulmonary resuscitation (CPR) had retinal haemorrhages after 60 min of CPR; the child had a coexistent clotting abnormality.

Although child abuse remains the most common cause of retinal haemorrhage, it is important to consider these other diagnoses when examining a child with retinal haemorrhages.

Reviewer: Kirsten Zahnow, kirsten_zahnow@health.qld.gov.au