Retinal haemorrhages occur when blood leaks from retinal capillaries into the surrounding retinal tissue.
Retinal haemorrhages are usually diagnosed by ophthalmologists, but they may be seen by ER, ICU, or hospitalist physicians. They are occasionally seen on MR SWI imaging.
Retinal haemorrhages that are associated with intracranial haemorrhage, usually subarachnoid haemorrhage, are referred to as 'Terson syndrome', as described by Terson in 1900 (he actually described the association between vitreous haemorrhage and intracranial haemorrhage). Another common term used is 'fundus haemorrhage'.
The only well-known incidence of infantile retinal haemorrhage comes from neonatal studies, where, in a recent study, 20% of full-term newborns were found to have retinal haemorrhages.1
Retinal haemorrhages are usually found in the setting of an acute infantile neurologic problem, such as seizure, lethargy, suspected or known head trauma.
Retinal haemorrhages can appear to the ophthalmologist in various shapes depending on the layer(s) of the retina affected. They have been described as dot/blot, boat-shaped, flame-shaped, or splinter-shaped.
Retinal haemorrhages can be seen on MR SWI imaging 2.
Treatment and Prognosis
Retinal haemorrhages usually resolve on their own within weeks of diagnosis. Severe haemorrhages can cause permanent visual loss.
Birth-related haemorrhages are typically gone by age 1 month. After that, infantile retinal haemorrhages are commonly associated with abusive head trauma; however, they can occur with other conditions that cause increased intracranial pressure or intracranial haemorrhage, such as accidental trauma or asphyxiation, cerebral venous thrombosis, stroke, and encephalitis.
- 1. Callaway NF, Ludwig CA, Blumenkranz MS, Jones JM, Fredrick DR1, Moshfeghi DM.Retinal and Optic Nerve Hemorrhages in the Newborn Infant: One-Year Results of the Newborn Eye Screen Test Study. Ophthalmology. 2016 May;123(5):1043-52
- 2. Zuccoli G, Panigrahy A, et al. Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma. Neuroradiology (2013) 55:889–893