Do corneal abrasions cause crying in neonates?

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Crying babies are a common presentation, and our list of differential diagnosis includes: viral and bacterial infections; fractures; hair tourniquets; intussusception; subdural haematomas; supraventricular tachycardia; and corneal abrasions. This study looks at the prevalence of corneal abrasions and aims to identify whether corneal abrasions are associated with fingernail length and increased crying.

Shope TR, Rieg TS, Kathiria NN. Corneal abrasions in young infants. Pediatrics. 2010;125(3):e565-9. 

Who did they look at?

Babies aged 1-12 weeks presenting for a routine appointment at the well baby clinic.

Patients were excluded if they were chronically or acutely unwell, or if they were allergic to fluorescein.

96 babies were included in the study.

What data was collected?

Parents completed a questionnaire on their baby’s crying/fussing behaviour in the preceding 24 hours.

They were also asked about nail cutting, and the nails were measured for length.

Finally, an eye examination was conducted under fluorescein staining.

What were the findings?

49% of patients had a corneal abrasions, and 7.3% had abrasions in both eyes.

27% of babies had never had their nails trimmed.

There was no association between crying (or nail length) and corneal abrasions. In fact, infants with corneal abrasions slept longer than those without.

What's the conclusion?

Although corneal abrasions in older children and adults are painful, this study shows that corneal abrasions in babies are common and can be asymptomatic.

We should be careful about attributing crying in babies to corneal abrasions.

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About 

Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa's DFTB posts