Retinopathy in Premature Infants


Retinopathy of Prematurity (ROP) which is also called Retrolental Fibroplasia can cause blindness. In the past, this disease was caused due to high amounts of oxygen used in incubators. However, nowadays, its incidence has decreased owing to the advances in premature infant’s care. The factors which expose infants to higher risk of retinopathy include low birth weight (less than 1.5 kg) and preterm labor (weeks 26 to 28). 

In premature children, growth and evolution of retinal blood vessels are impaired and abnormal blood vessels begin to grow. The problem of abnormal blood vessels called neovascularization is that they cannot carry sufficient oxygen to retina.

Retinopathy in premature infants is categorized to 5 stages, depending on its intensity. The progress of the disease to final stages can cause scars in the retina and complications such as retinal detachment, vitreous hemorrhage, strabismus and amblyopia. Most of the infants suffering from retinopathy will suffer from myopia.

Signs and Symptoms

Since infants cannot tell the symptoms to their parents, the pediatrician and ophthalmologist should consider the disease in the presence of the following risk factors:

  • Low birth weight (1.5 kg)
  • Oxygen supply in the first week after birth
  • The presence of a health problem in infant immediately after birth

Those children who suffered from this disease in infancy should be monitored for the following signs:

  • Holding objects near their eyes
  • Problem in seeing far objects
  • Closing and narrowing one eye
  • Unwillingness to use one eye
  • Blurred vision (which has not been formerly diagnosed by the physician)
  • Sudden decreased visual acuity 
  • Strabismus 

Diagnosis and Treatment

The infants with ROP risks should undergo ophthalmology examination in 4 to 6 weeks after birth. The ophthalmologist should first use dilating drops to make the pupil larger and then see the retina through an ophthalmoscope. The child should be held by a parent during the examination. Regardless of whether the patient needs the treatment or not, s/he should be re-examined at intervals specified by the ophthalmologist. Periodic examinations are necessary to determine whether disease progress has been stopped or not and whether there is a need for treatment or not. 


Some children at stage 1 or 2 will recover without any treatments. In other cases, if signs of grade 3 or higher are observed, it is required to treat parts of retina using cryotherapy in order to prevent from the spread of abnormal vessels. In this method, some parts of retina are frozen. Laser can also be used for this purpose. In both methods, permanent scars are left in peripheral parts of the retina; however, in most cases, treatment maintains patient's central vision.