Clinical Study
Eye (2007) 21, 5–10. doi:10.1038/sj.eye.6702174; published online 25 November 2005
Ocular manifestations of crush head injury in children
The authors have no proprietary interest in any of the materials used in this study. This study was supported in part by Brandan's Eye Research Fund
L Gnanaraj1, M G F Gilliland2, R R Yahya3, J T Rutka3, J Drake3, P Dirks3 and A V Levin1,4
- 1Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- 2Department of Pathology and Laboratory Medicine, Forensic Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- 3Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- 4Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Correspondence: AV Levin, Department of Ophthalmology, M-158, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8 Tel: +416 813 1076; Fax: +416 813 6261. E-mail: alex.levin@sickkids.ca
Received 28 April 2005; Accepted 11 May 2005; Published online 25 November 2005.
Abstract
Aims
To review the ocular manifestations of crush head injuries in children.
Methods
Retrospective clinical and pathological reviews. Group 1: A total of 16 children admitted with crush head injuries from television tip over. Group 2: Nine autopsy findings in crush head injury.
Results
Group 1: A total of 11 children had fundus examination: three by neurosurgeons, eight by ophthalmologists. Scattered posterior pole preretinal and blot haemorrhages extending to mid equator region observed in one child. No evidence of traumatic retinoschisis or retinal folds in any patient. Group 2: All with multiple skull fractures and six with subdural haemorrhage. Posterior pole retinal haemorrhages in four children, extending to the ora serrata in one after motor vehicle accident. No child had retinal folds. Subinternal limiting membrane haemorrhages in three children. Optic nerve sheath haemorrhage in three children.
Conclusions
Intraretinal and preretinal haemorrhages, predominantly in the posterior pole, can occur in crush injury to the paediatric head. Haemorrhage under the internal limiting membrane or extending to the ora serrata were only seen in situations where crush injury was part of a fatal trauma scenario related to motor vehicles. Retinal folds and the typical macular retinoschisis associated with abusive head injury were not observed.
Keywords:
crush head injury, retinal haemorrhage, traumatic retinoschisis, subdural haemorrhage
