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.
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.
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.
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.
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.