Perimacular Retinal Folds in the Shaken Baby Syndrome

We examined an infant with the diagnosis of shaken baby syndrome. Ophthalmologic examination showed no objective response to strong light. The pupils were fixed at 6 mm. There were no external signs of ocular trauma. Results of the anterior segment examination were normal. Ophthalmoscopic examination showed bilateral extensive diffuse subretinal, intraretinal and preretinal hemorrhages. Perimacular elevated ring-shaped retinal or subretinal folds were also noted in both eyes. The retinas looked folded over themselves, forming a ring-shaped ridge surrounded the macular region. There were also mild vitreous hemorrhages noted in both eyes. Computed tomography showed diffuse brain edema without evidence of subarachnoid hemorrhage. Records of the EEG examination showed diffuse cortical dysfunction suggestive of brain death. The child never regained consciousness, and expired on the 13th day after admission.