360 degree giant retinal tear as a result of presumed non-accidental injury

Giant retinal tears are defined as retinal tears extending 90 degrees or more around the circumference of the fundus. 1 They most commonly occur spontaneously but are associated with direct trauma in 20-25% of cases. 2, 3 We report the case of a 360 degree giant retinal tear occurring in a baby girl as a result of presumed non-accidental injury (NAI). Comment Giant retinal tears are commonly idiopathic (70%) but are associated with trauma in about 20% of cases. 3 Myopia is a common finding with 40% of eyes having more than 8 dioptres of myopia. 3 Non-traumatic giant retinal tears occur more frequently in males and tears occur in the fellow eye in about 10% of cases. 2 Kanski reviewed 100 eyes with giant retinal tears and found that 71% of eyes with non-traumatic breaks were myopic and severe retinal pathological findings were present in 57% of fellow eyes. 4 Idiopathic giant tears have been found in identical twins raising the question of genetic influences in the pathogenesis of this condition. 5 Ocular injury is the presenting sign of physical abuse in 4-6% of cases although it may be evident in up to 40% of abused children. 6 The commonest abnormality is retinal haemorrhage, which is the cardinal sign of shaken baby syndrome, occurring in some 80% of cases. 7 The next most common finding is periorbital oedema with subconjunctival haemorrhage. 7 Other manifestations reported include retinal detachment 8 and retinoschisis. 9 The collection of signs seen in this case, including retinal detachment, anterior lens opacity, bruising of the contralateral eye, MRI and electrophysiological findings are highly suggestive of NAI.