Retinal Hemorrhages in Children: The Role of Intracranial Pressure | Neuro-ophthalmology | JAMA Pediatrics | JAMA Network
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Review
July 2012

Retinal Hemorrhages in Children: The Role of Intracranial Pressure

Author Affiliations

Author Affiliations: Jefferson Medical College, Thomas Jefferson University (Ms Shiau and Dr Levin), and Pediatric Ophthalmology and Ocular Genetics, Wills Eye Institute, (Dr Levin), Philadelphia, Pennsylvania.

Arch Pediatr Adolesc Med. 2012;166(7):623-628. doi:10.1001/archpediatrics.2012.46
Abstract

Objective To evaluate the role of intracranial pressure (ICP) in the production of retinal hemorrhage in young children.

Design Review of published clinical, postmortem, and experimental research findings worldwide pertinent to our review objective. We used PubMed, MEDLINE, and Ovid Evidence-Based Medicine Reviews as well as references found in other published articles to conduct searches.

Main Exposures Increased ICP from various etiologies.

Main Outcome Measure Hemorrhagic retinopathy, in particular with extension to the periphery, multiple layers, and too-numerous-to-count hemorrhages. The review also considers additional intraocular findings such as retinoschisis and perimacular folds.

Results In general, elevated ICP does not cause extensive hemorrhagic retinopathy. Papilledema may be associated with a small number of hemorrhages on or around the optic disc. There are isolated case reports that severe hyperacute ICP elevation, unlike the subacute pressure increase in abusive head injury, in children may rarely result in extensive retinal hemorrhage. These diagnoses are readily distinguished from child abuse.

Conclusions In the absence of the few readily recognizable alternate scenarios, extensive retinal hemorrhage in very young children is not secondary to isolated elevated ICP.

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