Visual Effects of Shaken Baby Syndrome
Name of Condition: Shaken Baby Syndrome
Description of Condition: Due to the intracranial trauma of the brain being pitched back and forth while the
child is being shaken, Shaken Baby Syndrome causes Retinal Hemorrhages and Retinal Detachment. If not
treated in a timely manner, these can lead to vision problems including blindness.
Parts of Visual System Affected: Retinal hemorrhaging and detachment involve the Vitreous Humor, the
Retina, and depending on the extent of hemorrhaging or detachment the macula.
One specific retinal abnormality, traumatic retinoschisis, is essential to recognize as it is highly specific for
shaken baby syndrome and has never been described in any other condition of infants and young children in
the shaken baby range. At these ages, the vitreous is quite firmly adherent to the macula and retinal blood
vessels, much more so than in the adult. As a result, the shaking forces applied indirectly to the vitreous exert
shearing tractional forces on the retina, in particular the macula, causing it to split its layers, forming a cystic
cavity that may be partially or completely filled with blood. It also is important to avoid the common error in
identifying these blood collections as "preretinal" or "subhyaloid" (between the vitreous and the retina).
Recognition of traumatic retinoschisis is aided by the identification of hemorrhagic or hypopigmented
circumlinear ridges or lines at the edges of the lesion. These demarcations also have been called paramacular
folds. Schisis-like cavities also can form directly over blood vessels, although this is a less specific finding that
may be mimicked by virtually any disorder in which a major vessel can have a local bleed (e.g., vasculitis,
leukemia). The blood within a retinoschisis cavity may leak into the vitreous, making careful monitoring and
follow-up essential.
Effects on the condition of the Visual System:
Retinal Hemorrhage:
With a retinal hemorrhage the blood vessels of the retina fill with blood and burst. The effects of this depend on
the size and degree of bleeding that occurs. The effects may include:
 Blurred vision
 Light flashes
 Floaters that may be dark or red
 Loss of vision
Depending on the severity of the vitreous hemorrhage, it may take several months or significantly longer for the
body to reabsorb the blood and for the patient to regain vision. In addition to obstructing the patient's vision, a
vitreous hemorrhage often prevents physicians from seeing into the back of the eye to diagnose or treat the cause
of the hemorrhage. If extensive or repeated bleeding occurs, fibrous tissue or scarring can form on the retina,
which can lead to a detachment of the retina and permanent vision loss or blindness.
Myopic shift and amblyopia have been reported to follow long-standing vitreous hemorrhage in infants,
especially in those younger than 2 years.
Retinal Detachment:
When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal
detachment can cause permanent vision loss. When the retina detaches, it separates from the back wall of the
eye and is removed from its blood supply and source of nutrition. The retina will degenerate and lose its ability
to function if it remains detached. Central vision will be lost if the macula remains detached. Sometimes the
retinal hemorrhages are accompanied by nerve sheath damage or bleeding in the subdural space of the optic
nerve. Other times the hemorrhages are referred to as dot and blot hemorrhages or petechiae. These are thought to
suggest a lesser degree of force. Retinal hemorrhages in SBS cases are most often bilateral.
Common Treatments and Medications: With retinal hemorrhages treatment may not be necessary if damage is
minimal. Bed rest with the child’s head elevated for a few days may allow time for the blood to be re-absorbed
into the body. Other times, more intensive treatment may be necessary, such as:


Cryotherapy
Laser photocoagulation

Surgery to remove the blood
Retinal detachment may be prevented by treating a retinal tear and stopping the hemorrhaging. With retinal
detachment it must be caught early. Retinal detachments are treated with surgery that may require the patient
to stay in the hospital.
The most common methods of repairing a retinal detachment are:



Scleral buckling surgery
Pneumatic retinopexy
Vitrectomy
Anticipated Functional Implications: How soon surgery is needed usually depends on whether the
retinal detachment has or could spread far enough to affect central vision. Once the macula, the part of the
retina that provides central vision, loses contact with the layer beneath it, it quickly loses its ability to process
what the eye sees. Having surgery while the macula is still attached will usually save vision. But surgery
restores good vision in less than half of people who have surgery after the macula has already become detached.
The visual prognosis depends mainly on the pre-existing status of the retina before it detached. If the macula
has not detached, the pre-existing vision will usually be retained following successful repair. However if the
macula is detached and central vision is impaired by the detachment, there may be permanent loss of central
vision even if the retina is successfully repaired. The longer the macula is detached, the more likely there will be
loss of vision due to irreversible damage to the photoreceptor cells. In general, if the center of the macula is
detached for more than 4-5 days, there will be significant loss of central vision following surgical
reattachment.
References:
http://www.sbstruth.com/RH.htm
http://www.visionsimulator.com/dvh.asp#3
http://www.istavision.com/conditions/conditions_vitreous.asp
http://www.emedicine.com/emerg/topic789.htm
http://www.nei.nih.gov/health/retinaldetach/index.asp
http://www.emedicine.com/oph/topic421.htm
Levin AV. Ocular Manifestations of Child Abuse. In: Reece RM, Ludwig S, eds. Child Abuse: Medical Diagnosis and Management 2nd ed.
Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:99-100.