Version May 2024
| Condition* | Frequency of retinal hemorrhages | Hemorrhage description | Clinical features |
| Abusive head trauma | |||
| 50 to 100% of cases | Numerous, extend to retinal periphery, involve multiple layers of the retina | History inconsistent with injuries; commonly associated with subdural hemorrhage, fractures, bruising, and intraabdominal injury | |
| Perinatal retinal hemorrhages | |||
| 20 to 30% of newborns examined during first 24 hours 10 to 15% of newborns examined during first 72 hours | May be numerous and extend to retinal periphery; usually intraretinal, but may be preretinal or vitreal | More common in vacuum-assisted deliveries Resolves by 4 to 6 weeks | |
| Unintentional head injury | |||
| 0 to 10% of patients | Typically few in number and confined to posterior pole | Associated with severe mechanism of injury (eg, motor vehicle crash, fall from great height) | |
| Hematologic conditions | |||
| Bleeding disorder (eg, hemophilia, von Willebrand disease, vitamin K deficiency) | Unknown | All layers of retina, vitreous | Characteristic history of bleeding disorder and abnormal coagulation studies |
| Leukemia | Unknown; most patients have fundoscopic changes at some point in disease | Usually intraretinal at the posterior pole, but may occur in all layers and in the vitreous | Characteristic laboratory features (eg, lymphoblasts on peripheral blood smear) |
| Anemia (juvenile pernicious, iron deficiency, sickle cell) | Unknown, more common in adults than children | Intraretinal dot, blot, flame, or splinter | Anemia |
| Metabolic conditions | |||
| Glutaric aciduria type 1 | Rare | Few in number and confined to the posterior pole | Macrocephaly, characteristic basal ganglia findings, may present with subdural hematomas; absence of bony abnormalities |
| Galactosemia | Rare | Vitreous hemorrhage | Failure to thrive, cataracts |
| Infection | |||
| Cerebral malaria | 20 to 60% of children with severe cerebral malaria | Multiple white lesions | Travel history; fever, anemia, characteristic blood smear findings |
| Meningitis | Rare | Various | Fever, characteristic cerebrospinal fluid findings |
| Retinal infection (eg, CMV, HSV, toxoplasmosis, rickettsiae) | Rare | Small, intraretinal at areas of retinal necrosis; may span all layers of necrotic retina | Systemic signs of infection may be present; immunodeficiency |
| Endocarditis | Rare | White-centered oval hemorrhages | Other characteristic features (eg, cardiac murmur, fever, splinter hemorrhages in the nail beds, Janeway lesions) |
| Primary retinal disease | |||
| Retinopathy of prematurity | Rare | Small, usually intraretinal on the surface of the neovascular ridge; may extend to the vitreous | History of prematurity; retinal neovascularization |
| Coats disease | Rare | Usually intraretinal but may extend to vitreous | Usually unilateral; subretinal exudate; telangiectatic vessels |
| Persistent fetal vasculature | Rare | May present with vitreous hemorrhage | Usually unilateral; may be associated with mild microphthalmos; intralenticular hemorrhage; retrolental membrane |
| Other | |||
| Non-traumatic intracranial hemorrhage | Rare in absence of abusive head injury | Predominantly preretinal with vitreous hemorrhage adjacent to optic nerve head and posterior pole | Characteristic neuroradiographic features (eg, aneurysm, arterio-venous malformation) |
| Chest compression | |||
| Cardiopulmonary resuscitation | Rare if ever | Few in number, small in size | History of cardiopulmonary resuscitation |
| Thoracic crush injury (Purtscher syndrome) | Rare | Superficial; white retinal patches | History of thoracic injury |
CMV: cytomegalovirus; HSV: herpes simplex virus.
* The presence of an underlying condition does not exclude the possibility of abusive head trauma.This appendix is modified from an article entitled, "A 12-Year Ophthalmologic Experience with the Shaken Baby Syndrome at a Regional Children's Hospital" in the Trans Am Ophthalmol Soc 1999; 97:545-581 and republished with permission of the American Ophthalmological Society.
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