Retinal haemorrhages in infants: controversy and cases

Retinal haemorrhages in infants with a head and neck injury raise the possibility of non-accidental injury. Retinal haemorrhages also occur in a variety of other settings such as secondary to falls, raised intracranial pressure (Terson syndrome), coagulopathy and other blood disorders. The microscopic distribution of haemorrhages in the eye may indicate the aetiology of the haemorrhage. In trauma they are usually widespread, extend throughout the retinal layers into the periphery and involve the inner limiting membrane. There may be associated optic nerve and periorbital fat haemorrhage. However, it is becoming increasingly recognised that retinal haemorrhages alone are not diagnostic for non-accidental injury. Post-mortem neuropathology findings of a head and neck injury should also be considered in conjunction with other physical findings. We present four post-mortem cases aged 14 weeks, 4 months, 9 months and 2 years with retinal haemorrhages, head and neck injuries and histories ranging from a fall to the perpetrator pleading guilty to non-accidental injury.