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G90 SUBCONJUNCTIVAL HAEMORRHAGE IN VICTIMS OF CHILD ABUSE

S. Harty, C. Hobbs.St James’s University Hospital, Leeds, UK

Aim: Subconjunctival haemorrhage (SCH) is associated with pertussis infection (Paysse et al) and respiratory distress (Chiu et al) probably via increased intrathoracic pressure. Little is published about the relationship with trauma including abuse. The aims are to determine the frequency, pathogenesis, and the significance of SCH in children referred with suspected maltreatment.

Methods: Cases were identified retrospectively from a citywide paediatric child protection database and details obtained from reports and case notes. History, examination findings including eye and other injury, aetiology, and immediate outcome were studied.

Results: Twenty six cases (15 male, 11 female, age: range 1–184 months, mean 71 months) were identified between 1990 and 2005. Injury to the eye was the main presenting feature in eight (30.8%) cases. There was a history of blunt trauma in 17 including two with a history of asphyxia. Left eye alone was involved in 14 cases, right eye in nine, and both in three. 11 children had isolated SCH, 15 had additional eye injuries most commonly injury to the lids and periorbital tissues; one child had retinal haemorrhages. Additional non-ocular injuries in 20 included bruises (20), fractures (5), and burns (3). Eight children had history or findings suggestive of asphyxia (history of strangulation, petechiae, and epistaxis) including two with bilateral SCH. Three were isolated and five had periorbital injury. All eight had non-opthalmic injury and were more likely to have fractures (3/8) than those with no asphyxia (2/18). Eight were aged <1 year; all had isolated SCH and multiple non-ocular injuries. Infants were more likely to have been asphyxiated (5/8 v 5/18) than older children. A 3 month old with bilateral SCH and a nosebleed who died two weeks after these signs were attributed to constipation by medical staff, had multiple fractures …

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