Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1996 Apr;80(4):282–287. doi: 10.1136/bjo.80.4.282

Ocular and cerebral trauma in non-accidental injury in infancy: underlying mechanisms and implications for paediatric practice.

M A Green 1, G Lieberman 1, C M Milroy 1, M A Parsons 1
PMCID: PMC505449  PMID: 8703874

Abstract

AIMS: To determine the sites, mechanisms, and clinical significance of injuries to the eyes and brains of children with non-accidental injuries in relation to differing levels of trauma. METHODS: A forensic pathological study of injuries in the eyes and brains of 23 consecutive children dying of non-accidental injuries over a 4 year period (1988-92) under the jurisdiction of Yorkshire and Humberside coroners. RESULTS: Sixteen children died from cerebral injuries and seven died from non-cerebral causes. There were high incidences of retinal detachment (63%) and subhyaloid (75%), intraretinal (75%), and perineural (68%) haemorrhages in CNS deaths. Local subhyaloid haemorrhages and retinal detachment were more common at the periphery and optic disc than at the equator. There was a strong correlation between CNS and eye trauma scores in all 23 children (r = 0.7551, p < 0.0001). Ranking of injuries by severity suggests progressively more trauma required for (a) subdural haemorrhage, (b) subhyaloid, intraretinal, perineural haemorrhages, and (c) retinal detachment. At highest trauma levels choroidal and vitreous haemorrhages were associated with additional cerebral lacerations, intracerebral and subarachnoid haemorrhages. CONCLUSIONS: In non-accidental (and probably accidental) infantile head injury the earliest eye injuries (coinciding with subdural haemorrhage) could be missed if indirect ophthalmoscopy is not performed. Retinal detachment and multiple (particularly choroidal/vitreous) haemorrhages may indicate additional cerebral lacerations and/or intracerebral haemorrhage. Vitreous traction is the likely cause of intraocular pathology.

Full text

PDF
282

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Budenz D. L., Farber M. G., Mirchandani H. G., Park H., Rorke L. B. Ocular and optic nerve hemorrhages in abused infants with intracranial injuries. Ophthalmology. 1994 Mar;101(3):559–565. doi: 10.1016/s0161-6420(94)31300-5. [DOI] [PubMed] [Google Scholar]
  2. Caffey J. On the theory and practice of shaking infants. Its potential residual effects of permanent brain damage and mental retardation. Am J Dis Child. 1972 Aug;124(2):161–169. doi: 10.1001/archpedi.1972.02110140011001. [DOI] [PubMed] [Google Scholar]
  3. Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics. 1974 Oct;54(4):396–403. [PubMed] [Google Scholar]
  4. Carty H., Ratcliffe J. The shaken infant syndrome. BMJ. 1995 Feb 11;310(6976):344–345. doi: 10.1136/bmj.310.6976.344. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Duhaime A. C., Gennarelli T. A., Thibault L. E., Bruce D. A., Margulies S. S., Wiser R. The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg. 1987 Mar;66(3):409–415. doi: 10.3171/jns.1987.66.3.0409. [DOI] [PubMed] [Google Scholar]
  6. Fulginiti V. A., Kempe C. H. Killed-measles-virus vaccine. Lancet. 1967 Aug 26;2(7513):468–468. doi: 10.1016/s0140-6736(67)90887-2. [DOI] [PubMed] [Google Scholar]
  7. Gilliland M. G., Luckenbach M. W., Chenier T. C. Systemic and ocular findings in 169 prospectively studied child deaths: retinal hemorrhages usually mean child abuse. Forensic Sci Int. 1994 Sep 16;68(2):117–132. doi: 10.1016/0379-0738(94)90309-3. [DOI] [PubMed] [Google Scholar]
  8. Greenwald M. J., Weiss A., Oesterle C. S., Friendly D. S. Traumatic retinoschisis in battered babies. Ophthalmology. 1986 May;93(5):618–625. doi: 10.1016/s0161-6420(86)33688-1. [DOI] [PubMed] [Google Scholar]
  9. Hadley M. N., Sonntag V. K., Rekate H. L., Murphy A. The infant whiplash-shake injury syndrome: a clinical and pathological study. Neurosurgery. 1989 Apr;24(4):536–540. doi: 10.1227/00006123-198904000-00008. [DOI] [PubMed] [Google Scholar]
  10. Kleinman P. K. Diagnostic imaging in infant abuse. AJR Am J Roentgenol. 1990 Oct;155(4):703–712. doi: 10.2214/ajr.155.4.2119097. [DOI] [PubMed] [Google Scholar]
  11. Munger C. E., Peiffer R. L., Bouldin T. W., Kylstra J. A., Thompson R. L. Ocular and associated neuropathologic observations in suspected whiplash shaken infant syndrome. A retrospective study of 12 cases. Am J Forensic Med Pathol. 1993 Sep;14(3):193–200. doi: 10.1097/00000433-199309000-00004. [DOI] [PubMed] [Google Scholar]
  12. Sebag J. Anatomy and pathology of the vitreo-retinal interface. Eye (Lond) 1992;6(Pt 6):541–552. doi: 10.1038/eye.1992.119. [DOI] [PubMed] [Google Scholar]
  13. Spaide R. F., Swengel R. M., Scharre D. W., Mein C. E. Shaken baby syndrome. Am Fam Physician. 1990 Apr;41(4):1145–1152. [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES