Citation

Shiau T, Levin AV. Arch. Pediatr. Adolesc. Med. 2012; 166(7): 623-628.

Affiliation

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

Copyright

(Copyright © 2012, American Medical Association)

DOI

10.1001/archpediatrics.2012.46

PMID

22393175

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.

Language: en