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Clin Exp Ophthalmol. 2010 Jul;38(5):514-20. doi: 10.1111/j.1442-9071.2010.02291.x. Epub 2010 Mar 15.

Retinal haemorrhage in abusive head trauma.

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Pediatric Ophthalmology Service, Assaf Harofeh Medical Center, Zrifin.


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.

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