Table 5

Description of retinal haemorrhages in children with accidental head injuries

Age (years)AccidentType of haemorrhagesGrade*Other findings†
Under 2AsphyxiatedBilateral. Scattered intra-retinal, posterior pole and mid-periphery, 50% white-centred1SAH, HII, cerebral oedema, cortical venous thrombosis. No SDH
Over 2Knocked out by falling objectBilateral. Pre-retinal and deeper intra-retinal, including flame-shaped, white-centred and deeper blot retinal haemorrhages, posterior pole2Bilateral SAH
Over 2Fell 1–2 m from play equipmentBilateral. Numerous intra-retinal, posterior pole and mid-peripheral2Unilateral SDH
Under 2Fell 1.35 m, striking occiputBilateral. Several scattered blot haemorrhages around the posterior pole with occasional blot haemorrhages in periphery2Occipital skull fracture, unilateral SDH
Over 2Fell 1.5 m from play equipmentUnilateral. Occasional small flame haemorrhages, posterior pole. 1 small blot haemorrhage with a white centre, 2 small round pre-retinal adjacent to the central macula1Unilateral SDH and hemispheric infarction
Under 2Fell 2 mUnilateral. Two small intra-retinal haemorrhages, posterior pole1Parietal skull fracture, unilateral SDH
  • *Retinal haemorrhages graded following Vinchon.15

  • †Including negative skeletal surveys in five children ≤2 years old.

  • HII, hypoxic ischaemic injury; SAH, subarachnoid haemorrhage; SDH, subdural haemorrhage.