Orbital tissue injuries seen in infants with shaken-baby syndrome

ORLANDO, Fla. – Injury to the orbital tissues was observed in patients with shaken-baby syndrome, according to a study presented here.

“[Injury to orbital tissues] may explain the optic atrophy so often seen in shaken-baby syndrome and may also suggest pathophysiologic mechanisms involved with the generation of retinal hemorrhages,” reported Tamara Wygnanski-Jaffe, MD, and colleagues with Toronto’s Hospital for Sick Children and the Goldschleger Eye Institute in Tel Hashomer, Israel, in a poster presentation at the American Association for Pediatric Ophthalmology and Strabismus meeting.

The study authors compared the ocular findings in 18 children with shaken-baby syndrome, also known as inflicted childhood neurotrauma, to cadaver eyes of 19 children who died from accidental head trauma. Seventy-eight percent of patients with shaken-baby syndrome had findings of subdural optic nerve hemorrhage, 50% had findings of orbital fat hemorrhage and 30% had findings of extraocular muscle hemorrhage. Patients with shaken-baby syndrome also had findings of cranial nerve sheath hemorrhage, the poster authors noted.

In the cadaver group, subdural optic nerve hemorrhage was present in 64% of eyes. Unlike in the shaken-baby eyes, orbital fat hemorrhage and extraocular muscle hemorrhages were not present in most cases.

“Orbital fat/muscle hemorrhage similar to cases of shaken-baby syndrome was identified only in a case of direct orbit crush and a repetitive impact head trauma,” the researchers noted.