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  • Writer's pictureAtanas Bogoev M.D. and Maria Cholakova

Eye Problems in Premature Babies

Premature birth is a global health concern affecting millions of infants each year. Among the challenges preterm infants face, ophthalmic issues are of particular significance. Eye problems in premature babies result from a range of factors. Those factors may be incomplete ocular development, oxygen therapy, and hereditary conditions.

To make it clearer for you, we explore the complex landscape of eye problems in premature infants. We discuss their etiology, diagnosis, and management in this article.

Risk Factors for Ocular Issues in Premature Infants

Gestational Age

The gestational age at birth is a main determinant of the risk of eye problems in premature babies. The earlier a baby is born, the greater the eye vulnerability. Some of the major potential issues are retinopathy of prematurity (ROP) and cortical visual impairment (CVI). While not exclusively tied to gestational age, their severity may correlate with the degree of prematurity. Extremely premature infants are at the highest risk.

The balance of organ system development in the eyes and the brain makes them more prone to visual complications. Close monitoring, timely intervention, and a collaborative approach with doctors can mitigate the risks. They can also promote optimal visual outcomes for preterm babies.

Oxygen Therapy

Oxygen therapy is a life-saving intervention for preterm infants. It supports the development of essential organs, like the lungs, brain, and cardiovascular system. But it can also contribute to the development of eye problems in premature babies.

Babies born at extremely low gestational ages have underdeveloped retinas. These fragile blood vessels are sensitive to oxygen levels. Prolonged exposure to high levels of oxygen is common in neonatal intensive care units (NICUs) and can lead to abnormal blood vessel growth in the retina (ROP).

That's why doctors closely track oxygen levels in premature babies. The monitoring involves adjusting the amount of supplemental oxygen to meet the baby's specific needs. Each premature infant is unique, and their response to oxygen therapy can vary.

Neonatal care guidelines include recommended oxygen saturation targets. That way, they can prevent both hypoxia (insufficient oxygen) and hyperoxia (excessive oxygen). Advances in technology enable more precise monitoring and regulation of oxygen levels. And strike a balance between therapeutic benefits and potential harm.

eye problems in premature babies

Common Eye Problems in Premature Babies

1. Retinopathy of Prematurity (ROP)

Retinopathy of Prematurity (ROP) is a common ophthalmic concern in premature infants. When a baby is born too early, the eyes may not develop completely. The blood vessels in the retina, which is the back part of the eye (responsible for vision), are delicate and susceptible to damage. In ROP, abnormal blood vessels start to grow in the retina. If the new vessels are weak, there may be bleeding or scarring, which affects the baby's vision.

What Parents Should Know about ROP?

  • Premature babies with very low birth weight, born at early gestational ages (earlier than 28 weeks), are at higher risk

  • In extremely premature infants, the high levels of oxygen in the NICU can trigger abnormal blood vessel growth, leading to ROP

  • Regular eye check-ups for early assessment and management

  • We classify the severity of ROP into stages, ranging from mild (Stage 1) to severe (Stage 5).

  • Not all cases of retinopathy of prematurity result in vision problems

  • In many cases, the condition improves on its own as the baby grows

  • Treatment options include laser therapy or intraocular injections to stop the abnormal blood vessel growth

  • Adequate and on-time medical treatment can prevent vision loss

  • Another term for this condition is Preterm Retinopathy (PR)

2. Cortical Visual Impairment (CVI)

Cortical Visual Impairment (CVI) is a visual processing disorder. It affects premature infants' visual perception. In CVI, even though the eyes may be healthy, the brain struggles to interpret visual information correctly.

What Parents Should Know about CVI?

  • CVI is often seen in premature babies but can occur for various reasons

  • It's not about the eyes; it's about how the brain processes visual signals

  • Babies with CVI may show difficulty tracking objects

  • Babies with CVI may show difficulty responding to visual stimuli

  • Early intervention, such as visual stimulation and therapy, is essential

3. Strabismus

In strabismus, the eyes are not aligned properly. One eye may turn in, out, up, or down independently of the other eye. In strabismus, the misalignment of the eyes prevents them from focusing on the same point at the same time. The condition may affect the premature baby's overall vision development.

What Parents Should Know about Strabismus?

  • Strabismus is commonly known as "crossed eyes"

  • The condition can be present at birth or develop later in childhood

  • Strabismus may lead to double vision or poor depth perception

  • Treatment may involve glasses, eye exercises, or in some cases, surgery

  • Strabismus may cause amblyopia (lazy eye)

4. Amblyopia (Lazy Eye)

Amblyopia, also known as "lazy eye", occurs when one eye has better visual acuity than the other. It often develops due to strabismus or significant differences in refractive error between the eyes. It's one of the common eye problems in premature babies, even though it develops at a later stage, not right at birth.

What Parents Should Know about Lazy Eye?

  • Premature babies may be more prone to amblyopia

  • Premature babies are not born with lazy eye, but they can develop it later

  • Low birth weight and a family history of amblyopia may increase the risk

  • Look out for signs such as squinting, frequent eye rubbing, or one eye turning in or out

  • Early detection is vital for effective treatment

  • Treatment may involve glasses, eye patches, or other interventions to strengthen the weaker eye

  • Regular eye check-ups help identify and manage amblyopia

5. Refractive Errors (Myopia, Hyperopia, Astigmatism)

Premature infants can develop refractive errors such as myopia or hyperopia. They affect the baby's vision and ability to focus on objects at different distances.

Astigmatism is the result of irregular corneal or lens shape. Thus causing blurred or distorted vision.

  • Premature infants are at a higher risk of refractive errors, compared to full-term babies

  • Refractive errors may occur due to the incomplete development of the eye structures

  • Depending on the diagnosis, an eye doctor may prescribe eyeglasses or contact lenses at a later stage

  • An eye doctor should recommend the right vision correction tools for best learning experiences

6. Nystagmus

Nystagmus is an involuntary, rhythmic, and rapid eye movement that can affect eyesight. It may occur in preterm infants due to neurological factors or visual pathway abnormalities. This is one of the eye problems in premature babies that may be present from birth or develop later.

What Parents Should Know about Nystagmus?

  • Premature birth may be associated with nystagmus

  • The involuntary eye movements can affect vision and depth perception

  • It can cause difficulties with clear vision and may affect daily activities

  • Management may involve addressing underlying causes, visual aids, or therapies

  • Regular pediatric eye exams help monitor and manage nystagmus

  • Nystagmus is currently untreatable and likely to remain a lifelong condition (until new findings in the field)

7. Optic Nerve Abnormalities

Optic Nerve Abnormalities involve issues with the nerve connecting the eyes to the brain. Sometimes, premature babies have atypical optic nerve development. This affects their vision and visual field.

What Parents Should Know about Optic Nerve Abnormalities?

  • Premature birth may contribute to optic nerve abnormalities

  • Diagnosis often involves imaging tests (MRI or CT scans) to assess the optic nerve

  • Optic nerve issues may require collaboration with pediatric ophthalmologists or neurologists

  • Treatment depends on the specific abnormality

  • Treatment may involve monitoring or surgical intervention

  • Regular follow-ups with eye specialists are crucial for managing optic nerve issues

8. Congenital cataracts

cataracts schematics

Although less common, premature infants may develop eye problems like cataracts. Cataracts in premature babies involve clouding of the eye's lens, potentially affecting vision. The condition can be present at birth or develop shortly afterward. Cataracts may require surgical intervention.

What Parents Should Know about Cataracts?

  • Premature birth increases the risk of cataracts due to underdeveloped eye structures

  • The clouding of the lens can be subtle, so routine screenings are crucial for early detection

  • Surgical removal of the cataract is often necessary if it impacts vision

  • Cataract surgery in infants is a delicate procedure performed by specialized ophthalmologists

  • The baby may need visual rehabilitation post-surgery

  • Rehabilitation could involve the use of glasses or contact lenses

9. Glaucoma

Glaucoma entails increased pressure within the eye (intraocular pressure). In premature babies, the delicate balance of fluid production and drainage in the eye may be upset, elevating pressure levels. That could potentially damage the optic nerve, which is responsible for transmitting visual information to the brain.

What Parents Should Know about Glaucoma?

  • Premature infants may be at a higher risk of developing glaucoma

  • Premature babies can be born with glaucoma or develop it at a later stage

  • Glaucoma can have a subtle onset and be asymptomatic in the early stages

  • Parents should watch for excessive tearing, light sensitivity, or enlarged eyes

  • Regular checks of the premature baby's intraocular pressure are vital for detection

  • Timely intervention can prevent further damage and preserve vision.

  • Treatment options may involve medications, surgery, or a combination

  • There are different glaucoma types, consult a doctor for an accurate diagnosis

  • Glaucoma is often a chronic condition that requires monitoring throughout a person's life

General Advice for Parents of Premature Babies

Parenting a premature baby comes with unique challenges and considerations. As you embark on this journey, you need valuable information and strategies to provide the best possible care for your preterm infant.

Here is a general advice that may help you navigate the process:

  • Create an environment that fosters visual stimulation

  • Work closely with the healthcare team for regular check-ups

  • Be aware of any signs of vision problems and communicate with the baby's eye doctor

  • Early detection and appropriate intervention significantly improve outcomes for the baby's vision

  • Conditions affecting a child's vision can be challenging, and a supportive network is essential

Diagnosis of Ocular Issues in Premature Infants


Neuroimaging, such as magnetic resonance imaging (MRI) and computed tomography (CT), is valuable for diagnosing cortical visual impairment. It's the most reliable method to assess structural abnormalities in the visual pathways. It's also used to assess brain regions associated with visual processing.

Eye Exam

Regular eye examinations are crucial for identifying and monitoring eye problems in premature babies. Eye doctors can adequately assess retinal development. They can also screen for conditions like ROP and other abnormalities.

Long-term Implications and Quality of Life

Eye problems in premature babies may affect their visual and neurodevelopmental development. Here are some long-term implications and considerations for the quality of life in preterm infants with eye issues:

Developmental Milestones

Visual input also plays a role in a child's overall development. Eye problems related to baby prematurity may affect the attainment of developmental milestones. The good news is, early intervention and rehabilitation services can address developmental delays.

Educational Challenges

Premature children may have different levels of vision impairment. It depends on the eye problems they have. The severity of vision problems tends to affect the child's ability to perform daily activities, learn, and engage in social interactions.

Visual limitations also present challenges in a child's educational journey. Thankfully, specialized education programs and support services are available. They may address the unique needs of each individual. For children with blindness, screen readers can help them navigate the digital space.

Emotional and Social Impact

Eye problems in premature babies may influence their future emotional well-being. Support from family, friends, and doctors helps a child navigate social situations and build self-esteem. If your child grows up to have anxiety or other psychological issues due to their eye condition, child therapy may be an appropriate next step.

Family Dynamics

Each child is unique, and the impact of eye problems on their life will vary. The severity of the eye condition, access to medical care, and support systems all contribute to individual outcomes. We also understand caring for a child with visual impairment can place stress on the family. Support groups, counseling, and resources for parents help them develop better coping strategies. They also contribute to a healthier family dynamic.

Medical Interventions

Some premature babies with eye problems may need ongoing medical interventions, surgeries, eyedrops, or medication. They need these to manage their condition. These interventions could be temporary or lifelong. They can impact the child's and family's quality of life, requiring regular hospital visits and adjustments to daily routines.

Technological Advances

Advances in medical technology, including visual aids and assistive devices, are likely to enhance the quality of life for children with eye problems. Ongoing research and development may introduce new interventions and treatments.


Eye problems in premature babies represent a significant medical challenge. They necessitate a multidisciplinary approach to medical care. By addressing these challenges effectively, we can strive to provide the best possible visual outcomes and quality of life for premature infants.

Checked by Atanas Bogoev, MD.

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