Infantile 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.
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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 one study, 20% of full-term newborns were found to have retinal haemorrhages 1.
Clinical presentation
Retinal haemorrhages in infants are usually found in the setting of an acute neurological 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 prognosis
Retinal haemorrhages usually resolve on their own within weeks of diagnosis. Severe haemorrhages can cause permanent visual loss.
Practical points
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.
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