Retinal Hemorrhages are small hemorrhages on the back of the eye. Most experts do not agree as to the pattern, number, location or type of retinal hemorrhages that point to a diagnosis of SBS or other nonaccidental trauma. The mechanism(s) behind retinal hemorrhages in infancy in the context of alleged head trauma are unknown. Most research points to a mechanism involving rapid increases in intracranial pressure, cerebral venous spasm or increased venous pressure, and possibly hypoxia. Most studies do not support a mechanical etiology. The presence or absence of retinal hemorrhages and/or its characteristics is often used by prosecution doctors to determine whether or not the case is nonaccidental trauma. This is not a reliable mechanism. Sometimes, the retinal hemorrhages are accompanied by nerve sheath damage or bleeding in the subdural space of the optic nerve. This finding has been considered an indicator of a greater degree of damage. 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.

Retinal Hemorrhages

 

Retinal Hemorrhages

 

Conjunctival Hemorrhages

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