Retinal Hemorrhages in Children: The Role of Intracranial Pressure

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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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