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Traumatic macular retinoschisis in infants and children
Michelle Shouldice1, Fadiah Al-Khattabi2, Avrey Thau3
1The Hospital for Sick Children, Toronto, Ontario.
Insights
Pediatric traumatic retinoschisis is strongly linked to abusive head trauma, subdural hemorrhage, and poor neurological outcomes. Even with careful evaluation, this condition often indicates likely abuse in children.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Forensic Medicine
Background:
- Pediatric traumatic retinoschisis is a rare but serious ocular condition.
- Understanding its association with abusive head trauma is crucial for diagnosis and intervention.
Purpose of the Study:
- To detail the clinical presentation of pediatric traumatic retinoschisis.
- To explore the association between traumatic retinoschisis and abusive head trauma in children.
Main Methods:
- Retrospective review of medical records of children with abusive head trauma and traumatic macular retinoschisis.
- Extraction of clinical details and photographic documentation.
- Exclusion of ophthalmology findings in abuse evaluations to prevent bias.
Main Results:
- Of 134 suspected abusive head trauma cases, 31 had retinoschisis (mean age 9 months).
- All retinoschisis cases presented with seizures, vomiting, or altered responsiveness, and subdural hemorrhage; 55% had cerebral edema.
- 18 cases were deemed suspicious for abuse, 11 indeterminate, and 2 possibly accidental; 3 children died, 11 had neurological sequelae.
Conclusions:
- Pediatric traumatic retinoschisis is highly associated with subdural hemorrhage, neurological symptoms, and adverse outcomes.
- The findings suggest a strong link between traumatic retinoschisis and child abuse, even with conservative assessments.
Purpose:
To provide detailed description of pediatric traumatic retinoschisis.
Methods:
The medical records of children with either abusive head trauma and traumatic macular retinoschisis seen at a single center from 1993 to 2006 were reviewed retrospectively. Clinical details were extracted from the record and photographic documentation. Evaluation regarding abuse excluded ophthalmology findings to avoid circular reasoning.
Results:
Of 134 patients with suspected abusive head trauma, 31 had retinoschisis. Mean age was 9 months. Of the 31, 22 (71%) offered a history of injury, and 9 (29%) were found unresponsive without history of injury; 6 were reportedly shaken. All patients had seizures, vomiting, and/or altered responsiveness. All had subdural hemorrhage, with cerebral edema in 17 (55%). In 10 (32%), there were findings of blunt force head injuries; in 4 of these there was no impact history. Retinal hemorrhages were present in all cases. Agreement between sidedness of retinoschisis and subdural hemorrhage was poor. Eleven patients had retinal folds, 3 of which had a hemorrhagic edge to the schisis. Nine patients had extracranial manifestations of abuse. Multidisciplinary team adjudications were as follows: of the 31 cases, 18 were suspicious for abuse, 11 were indeterminate, and 2 were possibly accounted for by accidental severe crush injury. Three children died, and 11 suffered neurological sequelae.
Conclusions:
Traumatic retinoschisis in children is highly associated with subdural hemorrhage, neurologic symptoms, and poor outcomes. Even with a conservative approach to opinion formulation, traumatic retinoschisis was associated with likely abuse.
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