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

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

Vitreoretinal traction is a major factor in causing the haemorrhagic retinopathy of abusive head injury? – No

“…Further descriptions of circinate perimacular folds, considered to result from vitreoretinal traction attributable to shaking, followed. 10 Pathological support for the vitreous traction theory came from papers by Massicote et al 11 and Green et al 12 Massicote et al noted partial detachment of the vitreous except at the apices of retinal foldsFconfirming, in their view, the role of vitreous traction in the formation of folds.…”

A pitfall in the diagnosis of child abuse: external hydrocephalus, subdural hematoma, and retinal hemorrhages

“…[20,27] In infancy retinal hemorrhages have long been recognized as a distinctive feature of head injury caused by physical abuse, [13,28,42] but the physical mechanisms remain to be clarified. [15] One possibility is that the rupture of retinal veins is caused by a pressure surge transmitted either from the cranial cavity through the subarachnoid space of the optic nerve sheaths or from the chest through the cervicocephalic veins (the so-called Purtscher retinopathy). [42] Another possibility, by analogy with subdural hemorrhage, is that a direct acceleration-deceleration insult to the globe causes shear stresses between the ocular tissues with differing mechanical properties; this mechanism of injury is especially prominent in autopsy cases.…”

“…[42] Another possibility, by analogy with subdural hemorrhage, is that a direct acceleration-deceleration insult to the globe causes shear stresses between the ocular tissues with differing mechanical properties; this mechanism of injury is especially prominent in autopsy cases. [15,22] Because a gradation of inflicted ocular injury corresponds to the gradation of severity of the associated intracranial injury, [15,43] different mechanisms likely come into play in response to varying degrees of violence.…”

Update from the Ophthalmology Child Abuse Working Party: Royal College Ophthalmologists

“…Since retinal haemorrhages frequently coexist with subdural haemorrhages in severely damaged children, 26 the question often asked is did the same traumatic event cause bleeding in both sites, or did the retinal haemorrhages develop secondary to the intracranial bleeding.…”