For the past 20 years, vitreoretinal traction has been held to be a major mechanism for the generation of retinal haemorrhage in non-accidental injury in infancy. The presence of circinate macular folds, and a lesion termed ‘traumatic retinoschisis’ have been proposed as indicating severe vitreoretinal traction due to shaking, and by implication, only to result from the application of extreme violence. Some recent evidence, and clinical experience of the behaviour of partially detached vitreous, casts doubt on this hypothesis and this has implications for the degree of certainty with which the presence of retinal haemorrhage and circinate macular folds can be used as a marker for extreme violence done to an infant.

Child abuse is likely to be as old as humanity, but only recently has the combination of subdural and retinal haemorrhages with encephalopathy in infancy been recognised as being due, in some, if not all, cases, to inflicted trauma. The mechanism by which the trauma gives rise to the clinical findings remains the subject of hypothesis and conjecture.

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