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Anesthesia Strategies for Pediatric Ophthalmic Patients: Systematic Review of Recent Advances and Updates

Abdulrahman Mamoon Allaf1, Ta Chen Chang1, Neil H Masters2

  • 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St - Room 541, Miami, FL 331236 USA.

Current Ophthalmology Reports
|November 3, 2025
PubMed

Insights

This review highlights advances in pediatric ophthalmic anesthesia, focusing on reducing emergence agitation and improving care for retinopathy of prematurity (ROP) and children with comorbidities.

Area of Science:

  • Ophthalmology
  • Anesthesiology
  • Pediatrics

Background:

  • Pediatric ophthalmic anesthesia presents unique challenges, including managing emergence agitation and specific conditions like retinopathy of prematurity (ROP).
  • Children with developmental or medical comorbidities require tailored anesthetic approaches for ophthalmic procedures.

Purpose of the Study:

  • To review recent advancements in pediatric ophthalmic anesthesia.
  • To focus on emergence agitation, examination under anesthesia (EUA), ROP anesthesia strategies, and care for medically complex children.

Main Methods:

  • Review of current literature and emerging evidence in pediatric ophthalmic anesthesia.
  • Analysis of multimodal approaches, updated EUA protocols, and alternative ROP care strategies.

Main Results:

  • Multimodal anesthesia and specific agents (dexmedetomidine, methadone) show promise in reducing emergence delirium.
  • Streamlined EUA protocols and reduced anesthetic exposure are being implemented, with some cases managed without general anesthesia.
  • Alternative strategies for ROP care, including sedation for laser treatment, are under investigation.
  • Efforts are underway to minimize cumulative anesthetic exposure due to neurodevelopmental concerns.

Conclusions:

  • Pediatric ophthalmic anesthesia is moving towards safer, individualized patient care.
  • Targeted anesthetic techniques and minimized exposure are key to improving outcomes in pediatric ophthalmic surgery.
Abstract

Keywords:
Emergence deliriumExamination under anesthesiaPediatric anesthesiaPediatric ophthalmologyRetinoblastomaRetinopathy of prematurity

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