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Retinal Findings

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Review last updated in January 2015

There have been no new studies in 2014 to add to the meta-analysis of studies detailing retinal findings in children less than three years with a head injury.  The current meta-analysis highlights the association between retinal haemorrhage and abusive head trauma (odds ratio of  15.31, 95% CI 18.78-25.74). New studies relating to retinal haemorrhages in other disease states and newborn infants have been added. Increasing emphasis has been placed on the detailed pattern of retinal findings and whether these characteristics may aid in distinguishing abusive head trauma from other aetiologies 1. Ophthalmologists may also encounter children with direct trauma to the eye as a direct consequence of abuse and a recent review highlights the characteristics that may assist in identifying these injuries.  To date there are however no large scale comparison studies involving eye injuries due to abuse versus those due to accidental injury.

 

With the increased use of MRI, recent studies highlight the correlation between intracranial features and retinal haemorrhages 2. There are still no studies to date which set out to determine the evolution of retinal haemorrhages to enable dating of these injuries.

 

The review seeks to answer the following review questions:

  1. What differences are found between abusive head trauma retinal findings versus non-abusive head trauma retinal findings? (only include children < 11 years or where median age falls within this age range)

  2. What are the differential diagnoses of retinal haemorrhages in children with clinical features associated with child abuse? (only include children < 11 years or where median age falls within this age range)

  3. Retinal haemorrhages in newborn infants:

    a) What are the retinal findings in newborn infants?

     

    b) What are the obstetric correlates to retinal haemorrhages in the newborn?

     

    c) What is the evolution of newborn retinal haemorrhages?

     

  4. Can you date retinal findings in children? (only include children < 11 years)*

  5. Which features or characteristics of eye injury are present in child maltreatment, neglect and fabricated or induced illness? (only include children < 11 years or where median age falls within this age range)

 

 

*To date, there have been no studies that specifically set out to address this question

 

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References

  1. Levin AV. Ophthalmology of shaken baby syndrome. Neurosurgery Clinics of North America. 2002;13(2)201-11 [Pubmed]
  2. Binenbaum G, Christian CW, Ichord RN, Ying GS, Simon MA, Romero K, Pollock AN, Forbes BJ. Retinal hemorrhage and brain injury patterns on diffusion-weighted magnetic resonance imaging in children with head trauma. Journal of AAPOS. 2013;17(6):603-8 [Pubmed]

 

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