Anamika Tandon

Retinal haemorrhage description tool

Background Retinal haemorrhages are an important finding in children with abusive and accidental head trauma. There are no standardised and validated protocols to describe them in a consistent manner. The aim of this web-based study was to establish the reliability and validity of a new retinal haemorrhage description tool. Materials and method Our tool is a comprehensive questionnaire, which is applied using a retinal schematic that divides the retina into four independent zones. Four independent observers scored retinal haemorrhages from 80 retinal photographs. Inter- and intra-rater agreement (by repeat assessment of 10 photographs for each examiner) were calculated using Fleiss κ statistics. Results A high inter-rater agreement was noted for haemorrhages in the peripapillary zones, whereas agreement was only fair for all other zones. Intra-rater agreement was high only for the posterior pole. Photographs may be an unreliable way of documenting retinal haemorrhages particularly from the peripheral retina, thus underscoring the importance of a thorough clinical examination. Conclusion This study shows that the tool achieves some validity for describing haemorrhages in the posterior retina. It performs less well in the peripheral zones.

Raised intracranial pressure and retinal haemorrhages in childhood encephalopathies

To explore the relationship between raised intracranial pressure (RICP) and retinal haemorrhages in traumatic and non‐traumatic childhood encephalopathies.

Abusive head trauma and the eye in infancy

A child suspected of having an abusive head trauma (AHT) is referred by paediatricians to an ophthalmologist for evaluation. The incidence of abusive head injury in children is highest in infancy and less frequently seen in children over 3 years of age. Retinal haemorrhages (RHs) have a high positive predictive rate for abusive head injury. In the presence of head injury without any plausible medical explanation the description of the retinal findings help in distinguishing between abusive injury and other causes. It is incumbent on the ophthalmologist to be familiar with the clinical presentation, the differential diagnosis, and controversies associated with attributing the presence or absence of retinal findings to abusive head injury in children. The guidance was developed by a guideline working party (GWP) from the Royal College of Ophthalmologists (RCO) and the Royal College of Paediatrics and Child Health (RCPCH). It brings together previous publications of the RCO1, 2, 3 and an update of the literature since these publications. The publication is a summary of the updates of the full version of the document, with its appendices available on the websites of the RCO (www.rcophth.ac.uk) and the RCPCH (www.rcpch.ac.uk).

Transient visual loss and isolated disk edema in juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma is a well-described but rare benign tumor that mainly affects adolescent boys. Although it is capable of extravagant local extension and tissue destruction, the tumor is amenable to effective therapy. Ocular or visual complications have been little noted in the literature. We report a case whose sole symptom was unilateral transient visual impairment and findings were limited to a nonspecific optic disk edema.

Raised intracranial pressure and retinal haemorrhages in childhood encephalopathies: reply to the commentary by Squier

FOLLOW-UP About 30% of children will develop unilateral cerebral palsy (LE2). Epilepsy is reported in 15% to 20% of cases and is strongly associated with poor cognitive outcome (LE2). Despite an intelligence quotient within normal ranges in most cases, children with NAIS have weaker cognitive scores compared with controls (LE2). A multidisciplinary team with expertise in physical medicine and rehabilitation must conduct systematic assessments of motor skills, cognitive impairment, behavior, autonomy, quality of life, and participation, using reliable tools and repeating the process throughout adolescence (Grade C). Intensity and type of treatment are adapted according to a comprehensive care plan for the child and family (Grade C). On clinically detected disorders, we recommend early intervention, because data on brain plasticity suggest that ‘post-lesion’ neuroplasticity appears to be greater with this practice (Grade B).