What you should know if your NICU baby is getting an eye exam.

June 24, 2021

I'm katie, OTD, OTR/L, NTMTC, CNT & founder of blooming littles

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Did you know babies who spend time in the NICU may need an eye exam during their stay? Let’s talk a little bit about eye exams in the NICU, what they look like, whether your baby will need one, and how you can comfort your baby during the procedure.

Why do babies in the nicu get eye exams?

The most common reason why babies in the NICU get eye exams is because of premature birth. When a baby is born premature, the blood vessels in their eyes are fragile. They are immature and in the process of growing and connecting with one another. When a baby is born early, it can disrupt this process.

This can lead to a diagnosis called Retinopathy of Prematurity (ROP). Preemies are at an increased risk of being diagnosed with ROP.

Babies may also get eye exams in the NICU if they have a diagnosis or genetic condition that impacts their visual system or the structural development of their eye.

What is Retinopathy of Prematurity?

Retinopathy of prematurity is a common diagnosis in the NICU given to infants born prematurely. It is a disease of the eye that has varying levels of severity and is classified based on three different categorizations, zones, stages, and ‘plus disease’.

Babies who are born at less than 32 weeks gestation are at the greatest risk for having or developing ROP. ROP may begin as a mild diagnosis, requiring no medical intervention. But, the disease can progress, so your baby’s medical team will continue to do eye exams to monitor for further progression of the disease.

At its most severe, ROP can lead to retinal detachment and blindness. That is why early assessment of your baby’s eyes is so important.

What happens during an eye exam?

If you have talked with NICU families or nurses about eye exams, you may have heard some frightening things.

An eye exam looks pretty invasive, and it can be a tough procedure for parents and providers to watch. I don’t want to overwhelm you by sharing that, but I also don’t want you to feel thrown off guard either.

I want to walk you through what happens, so you can know what’s coming if you’re visiting your baby during an eye exam or are wondering what happens.

Before the eye exam, your baby’s nurse is going to give them some eye drops in their eyes that are going to dilate their pupils. This helps the ophthalmologist (doctor specializing in the eye) see clearly when they do the exam.

When the ophthalmologist comes to do the exam, they’re going to be wearing a set of microscopic glasses, so they can look into your baby’s eye. They will also have a small handheld tool that is used to hold your baby’s eye open during the exam. It kind of looks like a tong. 

The doctor will place the tool in your baby’s eye to hold it open, and then look into the eye with a light to assess the blood vessels. After looking at one eye, the ophthalmologist will remove the clamp and repeat on the other eye. 

There should be someone else at the bedside who is focused on comforting your baby during the procedure.

Will my baby need an eye exam?

Every hospital has a different set of guidelines for babies who will receive an eye exam in the NICU. Commonly, if your baby was born before 30 weeks, then they will likely receive an eye exam before they discharge home. 

Typically, ophthalmologists won’t do the first eye exam until your baby reaches 30 weeks old. Then, your baby will continue to get them on a schedule based on the doctor’s findings.

How often will my baby get an eye exam?

This is dependent on the findings of your baby’s first exam and the ophthalmologist’s recommendation. Babies typically get eye exams every one to two weeks. 

If your baby’s eyes are showing progression of ROP, the ophthalmologist will likely want to get an eye exam every week to monitor the severity and assess the need for possible medical intervention.

How can I calm my baby during their exam?

Eye exams are stressful experiences for babies but are a necessary part of medical and developmental assessment in the NICU, especially since we know premature babies are at a high risk for ROP. The good news is, there has been a lot of good research focused on ways we can prevent pain and stress for babies during eye exams.

If you are at the bedside and want to be the one to provide these for your baby, talk with your nurse and go for it! If you’re not ready and would rather step out during the procedure, then talk with your baby’s nurse about ways they can step in to comfort your baby. You can even give them some of these ideas.

Here are some proven methods that decrease the pain responses of babies during an eye exam:

  • Provide containment for your baby through a hand hug or swaddle. Give them time to settle in with your touch before the exam starts.
  • Offer your baby a pacifier.
  • Place some breast milk on a pacifier or on your baby’s tongue. Breast milk is sweet and an effective way to decrease your baby’s pain.
  • Ask if you can hold your baby skin-to-skin during the exam. This is NOT common practice, so don’t be surprised if the medical team says, “Absolutely not.”

What should I do after the exam is over?

When the exam is over, your baby’s eyes may look red or even puffy. They may be showing some signs of stress, like a stop hand, facial grimace, or may have had a bradycardic (drop in heart rate) or desaturation (drop in oxygen) event during the procedure.

It’s time to comfort your babe in a low stimulation way.

If you’re not able to get your baby out for holding or skin-to-skin care at this time, place your hands on your baby and give them a hand hug. Talk to them quietly or hum a sweet lullaby (like Twinkle Twinkle Little Star).

If you can, ask the nurse if you can hold your baby skin-to-skin for a couple hours after the exam. Your body is medicine for your baby!! It’s comforting and regulating. Kangaroo care after an eye exam provides them with a positive touch experience after a stressful event. This supports their brain, as it learns about their environment and creates positive sensory processing experiences.

I’ll be honest, eye exam day is no one’s favorite day. 

Because it’s stressful for babies, it’s usually best to keep interactions to a minimum and focus on providing comforting experiences for your baby for the remainder of the day.

If your baby is taking bottles or breastfeeding, getting an eye exam may impact how well your baby does that day. Don’t be discouraged (easier said than done, I know!), your baby will “bounce back” with some time.

As stressful as eye exams can be, they are a valuable tool to monitor your baby’s visual development. I hope this gives you an idea of what to expect and also empowers you to comfort your baby during the eye exam, if it is something you want to do. If not, take a step out.

I’m proud of you, you’re doing really hard things and are the absolute best parent for your little one!

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