|a) There are white-centered superficial intraretinal hemorrhages squares and deep intraretinal hemorrhages arrowhead b) some superficial intraretinal hemorrhages squares and less obvious deep intraretinal hemorrhages|
Retinal hemorrhage (UK English: retinal haemorrhage) is a disorder of the eye in which bleeding occurs in the retina, the light sensitive tissue, located on the back wall of the eye. There are photoreceptor cells in the retina called rods and cones, which transduce light energy into nerve signals that can be processed by the brain to form visual images. Retinal hemorrhage is strongly associated with child abuse in infants and young children and often leaves such abused infants permanently blind. In older children and adults, retinal hemorrhage can be caused by several medical conditions such as hypertension, retinal vein occlusion (a blockage of a retinal vein), anemia, leukemia or diabetes.
Signs and symptoms
At the early stage, a retinal hemorrhage may not show any symptom at all.
Some symptoms may include:
- Seeing floaters in the vision
- Seeing cobwebs in the vision
- Seeing haze or shadows
- Distorted vision
- Rapid flashes of light in peripheral vision
- Red tint to vision
- Sudden blindness
In adults, retinal hemorrhages are largely spontaneous, secondary to chronic medical conditions such as hypertension. They also commonly occur in high altitude climbers, most likely due to the effects of systemic hypoxia on the eye. Risk is correlated with the maximum altitude reached, duration of exposure to high altitude conditions, and climb rate.
In infants, retinal hemorrhages (RH) are highly associated with child abuse. The incidence of RH in abusive head trauma is approximately 85%. In a comprehensive review of 62 studies comprising 998 children, 504 of whom were abused, RH were found in 78% of cases of abusive head trauma (AHT) versus 5% of the cases of non-abusive head trauma. In a child with head trauma and RH, the odds ratio that this is AHT is 14.7 (95% CI 6.39, 33.62) and the probability of abuse is 91%. Where recorded, RH were bilateral in 83% of AHT cases compared to 8.3% in non-abusive cases.
The generally accepted body of medical literature is strongly in favor of the tight association between retinal hemorrhages and child abuse, and there is no controversy among mainstream medicine. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. These theories are perpetuated by a small group of fringe doctors regularly testifying for the defense in cases of child abuse, citing case reports and weak scientific papers, that RH is not caused by shaking.
A retinal hemorrhage is generally diagnosed by using an ophthalmoscope or fundus camera in order to examine the inside of the eye. A fluorescein angiography test may be conducted, in which a fluorescent dye is often injected into the patient's bloodstream beforehand so the administering ophthalmologist can have a more detailed view and examination on the blood vessels in the retina. The fluorescent dye can have dangerous side effects: see Fluorescein
Eye examination may be done to check the eye(s) conditions, for instance to check how well the patient sees straight ahead, off to the sides and at different distances.
Blood tests may provide information about the patient's overall health and may also reveal the medical condition that may have caused retinal hemorrhage.
It is recommended to consult with ophthalmologist or optometrist as early as possible, particularly for people with vision problems, these includes floaters, flashes, cobwebs or spots in their vision. Preventive measures such as regular prenatal care and monitoring of infants with high risks of the disorder may be done to avoid further complications of retinal hemorrhages in infants. For retinal hemorrhages associated with hypertension, blood pressure can be controlled by having regular blood pressure check ups, frequent exercise, monitor daily food intakes and to practice a stress-free lifestyle.
Retinal hemorrhages, especially mild ones not associated with chronic disease, will normally reabsorb without treatment. Laser surgery is a treatment option which uses a laser beam to seal off damaged blood vessels in the retina. Anti-vascular endothelial growth factor (VEGF) drugs like Avastin and Lucentis have also been shown to repair retinal hemorrhaging in diabetic patients and patients with hemorrhages associated with new vessel growth.
Alternative treatments may include providing necessary nutrients to strengthen and heal damaged blood vessels, through the consumption of dietary supplements such as Vitamins A, B, C and E. Also, the essential fatty acids including omega-3 from fish oil and flaxseed oil.
- ↑ 1.0 1.1 "Retinal Hemorrhage - What You Need to Know". Drugs.com. Archived from the original on 2018-09-13. Retrieved 2018-09-13.
- ↑ Yarfitz S, Hurley JB (May 1994). "Transduction mechanisms of vertebrate and invertebrate photoreceptors". The Journal of Biological Chemistry. 269 (20): 14329–32. doi:10.1016/S0021-9258(17)36620-6. PMID 8182033.
- ↑ 3.0 3.1 3.2 "Consensus Statement: Abusive Head Trauma in Infants and Young Children". Pediatrics. 142 (2). 2018-08-01. doi:10.1542/peds.2018-1504. ISSN 0031-4005. PMID 30061300. S2CID 51878771. Archived from the original on 2022-07-29. Retrieved 2022-04-25.
- ↑ Bosch MM, Barthelmes D, Landau K (December 2012). "High altitude retinal hemorrhages--an update" (PDF). High Altitude Medicine & Biology. 13 (4): 240–4. doi:10.1089/ham.2012.1077. PMID 23270439. Archived (PDF) from the original on 2022-04-19. Retrieved 2022-04-25.
- ↑ Kivlin, J (July 2000). "Shaken baby syndrome". Ophthalmology. 107 (7): 1246–1254. doi:10.1016/s0161-6420(00)00161-5. ISSN 0161-6420. PMID 10889093. Archived from the original on 2022-07-29. Retrieved 2022-04-25.
- ↑ Morad, Yair; Kim, Yuri M; Armstrong, Derek C; Huyer, Dirk; Mian, Marcellina; Levin, Alex V (September 2002). "Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome". American Journal of Ophthalmology. 134 (3): 354–359. doi:10.1016/s0002-9394(02)01628-8. ISSN 0002-9394. PMID 12208246. Archived from the original on 2022-07-29. Retrieved 2022-04-25.
- ↑ Maguire, S A; Watts, P O; Shaw, A D; Holden, S; Taylor, R H; Watkins, W J; Mann, M K; Tempest, V; Kemp, A M (January 2013). "Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review". Eye. 27 (1): 28–36. doi:10.1038/eye.2012.213. ISSN 0950-222X. PMC 3545381. PMID 23079748.
- ↑ 8.0 8.1 "Retinal Hemorrhage". TheFreeDictionary.com. Archived from the original on 2018-09-13. Retrieved 2018-09-13.
- ↑ Sparks KO. "Retinal Bleeding". LARetinaSurgeon.com. Archived from the original on 2015-02-13. Retrieved 2022-04-25.
- ↑ Spaide RF, Fisher YL (March 2006). "Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage". Retina. 26 (3): 275–8. doi:10.1097/00006982-200603000-00004. PMID 16508426. S2CID 8262505.
- ↑ "Age-Related Macular Degeneration Treatment". WebMD. Archived from the original on 2014-11-15. Retrieved 2022-04-25.
- ↑ Pilyugina S. "Retinal Physician - Ocular Dietary Supplementation — Food For Thought". Retinal Physician. Archived from the original on 2018-09-13. Retrieved 2018-09-13.
- Currie AD, Bentley CR, Bloom PA (March 2001). "Retinal haemorrhage and fatal stroke in an infant with fibromuscular dysplasia". Archives of Disease in Childhood. 84 (3): 263–4. doi:10.1136/adc.84.3.263. PMC 1718691. PMID 11207180.
- Zuccoli G, Panigrahy A, Haldipur A, Willaman D, Squires J, Wolford J, Sylvester C, Mitchell E, Lope LA, Nischal KK, Berger RP (July 2013). "Susceptibility weighted imaging depicts retinal hemorrhages in abusive head trauma". Neuroradiology. 55 (7): 889–93. doi:10.1007/s00234-013-1180-7. PMC 3713254. PMID 23568702.