Infantile retinal haemorrhage

RetinalInfantile retinal haemorrhages occur when, in infants, 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.

Terminology

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'.

Epidemiology

The only well-known incidence of infantile retinal haemorrhage comes from neonatal studies, where, in a recentone study, 20% of full-term newborns were found to have retinal haemorrhages ¹.

Clinical Presentationpresentation

Retinal haemorrhages in infants are usually found in the setting of an acute infantile neurologic problemneurological illness, such as seizure, lethargy, suspected or known head trauma.

Pathology

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.

Radiographic features

Retinal haemorrhages can be seen on MR SWI imaging ².

Treatment and Prognosisprognosis

Retinal haemorrhages usually resolve on their own within weeks of diagnosis. Severe haemorrhages can cause permanent visual loss.

Practical Pointspoints

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.