Contributor: Gordon K. Klintworth
Hemorrhages in the retina have many causes (including diabetic retinopathy [retinopathy - diabetic], hypertensive retinopathy [retinopathy - hypertensive], physical trauma, bleeding diathesis and increased intracranial pressure). The clinical appearance of the hemorrhage depends on the location of the hemorrhage within the retinal layers. Hemorrhage in the nerve fiber layer spreads between axons and causes a flame-shaped or splinter appearance on funduscopy. Deep retinal hemorrhages tend to be round. When located between the retinal pigment epithelium and Bruch membrane, blood appears as a dark mass and clinically resembles a melanoma.
The differential diagnosis of retinal hemorrhages in infancy includes birth trauma, hemorrhagic disorders (severe anemia, thrombocytopenia, acute leukemia [leukemia - acute], a coagulation disorder) and the shaken baby syndrome. Hemorrhage can accumulate in the space betweeen the sensory retina and retinal pigment epithelium. Blood in this location leads to retinal detachment.
In the shaken baby syndrome intracranial hemorrhage [hemorrhage - intracranial] is usually associated with the retinal hemorrhages. Accidents, even severe head-on automobile accidents, rarely produce hemorrhages in children. Similarly falls even from 3 or more stories, do not produce retinal hemorrhages. Systemic diseases such as leukemia and subacute bacterial endocarditis [endocarditis - subacute bacterial] may result in retinal hemorrhage, but the systemic disease has been diagnosed by the time retinal hemorrhages develop.