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Appearance and location of retinal haemorrhages in critically ill children
  1. G G W Adams1,2,
  2. Shruti Agrawal3,
  3. Rajnish Sekhri4,
  4. Mark J Peters5,6,
  5. Christine M Pierce5
  1. 1Department of Strabismus and Paediatrics, Moorfields Eye Hospital, London, UK
  2. 2Department of Paediatric Ophthalmology, Great Ormond Street Hospital for Children, London, UK
  3. 3Paediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK
  4. 4Department of Paediatric Ophthalmology, Hull and East Yorkshire Eye Hospital, Hull, UK
  5. 5Paediatric and Neonatal Intensive Care Units, Great Ormond Street Hospital for Children, London, UK
  6. 6Critical Care Group—Portex Unit, Institute of Child Health, University College London, London, UK
  1. Correspondence to GGW Adams, Department of Strabismus and Paediatrics, Moorfields Eye Hospital NHS Trust, 162 City Road, London EC1V 2PD, UK; gill.adams{at}


Background There are few high-quality studies describing the appearance and location of retinal haemorrhages in critically ill children not due to birth or abusive head trauma.

Methods Prospective study from February 2008 to December 2009 of emergency admissions to a paediatric intensive care unit aged over 6 weeks. Children with a penetrating eye injury or suspected or proven abusive head injury were excluded. The children underwent either dilated funduscopy performed by a paediatric ophthalmologist or RetCam imaging.

Results Retinal haemorrhages were identified in 24/159 (15%) patients. 50% of the haemorrhages were bilateral. The severity was mild (<5 retinal haemorrhages) or moderate (5–20 retinal haemorrhages) in 75%. The location was in zone 1 in 45.8%, zones 1 and 2 in 33.3%, zone 2 alone in 8.3% and not described in 8.3%. Schisis cavities and perimacular folds were identified in two patients with one having a pseudohypopyon appearance; a further one patient had bilateral haemorrhagic retinal detachments. Three patients had exudates or scarring consistent with cytomegalovirus infection.

Conclusions Retinal haemorrhages are seen in a proportion of critically ill children, however most retinal bleeding is not extensive as indicated by location within the retina or layer of bleeding. Higher numbers and extent of retinal haemorrhages were only observed in the presence of severe coagulopathy, leukaemia, one victim of a road traffic accident, and one child who sustained a fatal witnessed fall down the stairs; all circumstances that would be readily distinguished by history and laboratory testing from abusive head injury.

  • Child health (paediatrics)
  • Retina

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