Development of a finite-element eye model to investigate retinal hemorrhages in shaken baby syndrome.

Retinal hemorrhages (RH) are among injuries sustained by a large number of shaken baby syndrome victims, but also by a small proportion of road accident victims. In order to have a better understanding of the underlying of RH mechanisms, we aimed to develop a complete human eye and orbit finite element model. Five occipital head impacts, at different heights and on different surfaces, and three shaking experiments were conducted with a 6-week-old dummy (Q0 dummy). This allowed obtaining a precise description of the motion in those two specific situations, which was then used as input for the eye model simulation. Results showed that four parameters (pressure, Von Mises stress and strain, 1st principal stress) are relevant for shaking-fall comparison. Indeed, in the retina, the softest shaking leads to pressure that is 4 times higher than the most severe impact (1.43 vs. 0.34 kPa). For the Von Mises stress, strain and 1st principal stress, this ratio rises to 4.27, 6.53 and 14.74, respectively. Moreover, regions of high stress and strain in the retina and the choroid were identified and compared to what is seen on fundoscopy. The comparison between linear and rotational acceleration in fall and shaking events demonstrated the important role of the rotational acceleration in inducing such injuries. Even though the eye model was not validated, the conclusion of this study is that compared to falls, shaking an infant leads to extreme eye loading as demonstrated by the values taken by the four mentioned mechanical parameters in the retina and the choroid.