Infantile retinal hemorrhage

Infantile retinal hemorrhages occur when, in infants, blood leaks from retinal capillaries into the surrounding retinal tissue.

Retinal hemorrhages 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 hemorrhages that are associated with intracranial hemorrhage, usually subarachnoid hemorrhage, are referred to as 'Terson syndrome', as described by Terson in 1900 (he actually described the association between vitreous hemorrhage and intracranial hemorrhage). Another common term used is 'fundus hemorrhage'.

Epidemiology

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

Clinical presentation

Retinal hemorrhages in infants are usually found in the setting of an acute neurological illness, such as seizure, lethargy, suspected or known head trauma. 

Pathology

Retinal hemorrhages 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 hemorrhages can be seen on MR SWI imaging ².

Treatment and prognosis

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

Practical points

Birth-related hemorrhages are typically gone by age 1 month. After that, infantile retinal hemorrhages are commonly associated with abusive head trauma; however, they can occur with other conditions that cause increased intracranial pressure or intracranial hemorrhage, such as accidental trauma or asphyxiation,  cerebral venous thrombosis, stroke, and encephalitis.