Shaken Baby Syndrome: the Role of Ophthalmologist.

Background: Physicians, thanks to the different clinical presentation of the cases, could overlook the diagnosis of Shaken Baby Syndrome (SBS). The finding of an intraocular bleeding is a major diagnostic sign. The role of the ophthalmologist is critical, because a funduscopic examination in mydriasis is often crucial for diagnosis. Aim: To assess the cases of suspected SBS sent to the ophthalmologists of the Department of Paediatrics of Padua (3rd level hospital) from 2002 to 2005 for an examination. Methods: We reviewed all clinical file records of suspected cases of SBS seen by ophthalmologists of the Department, both of hospital admissions and of outpatient visits. Results: Eight patients were visited (mean age of 6 months) and underwent an indirect funduscopic examination, four of them with Ret-Cam. All patient showed retinal haemorrhages: 7 diffused bilateral intra-retinal haemorrhages, 6 had also relevant pre-retinal haemorrhages and 1 had haemorrhage of the optical nerve. One case showed only conjunctiva haemorrhages. Four patients have been seen for the functional follow-up (visual acuity test, fundus examination, refraction test, PEV-flash) and showed a low visual acuity and low PEV. Only in 1 case it was possible to start a programme of visual rehabilitation. Conclusions: The ophthalmologic findings have been very useful to make diagnosis of SBS, above all retinal haemorrhages, but the cases represent an underestimation of SBS. There is reluctance in sending the suspected cases to the ophthalmologist. Moreover, SBS represents an important cause of visual loss, due to the cerebral visual impairment. Ophthalmologists’ role is crucial also for the prognosis and prise en charge of the patient, but a complete follow-up has been possible only in one case. This is a critical point needing further research.