The birth of a premature baby, or preemie, often raises questions about their development. Preemies are infants born before 37 weeks of gestation, meaning their developmental milestones, including eye opening, may differ from full-term babies. This article clarifies eye development and what to expect regarding eye opening in premature infants.
Typical Fetal Eye Development
Eye development begins early in pregnancy. Around 22 days after conception, the eyes start forming as outgrowths from developing brain tissue. By the sixth week, key eye structures like the cornea, iris, pupil, lens, and retina begin to develop.
Eyelids form around 8 weeks of gestation and fuse by 9 to 12 weeks. This fusion protects delicate developing eye structures. Fused eyelids remain closed until approximately 26 to 28 weeks of gestation, when they reopen. During this period, the eyes continue to develop, and by 16 weeks, the fetus can sense light despite closed eyelids.
Factors Influencing Eye Opening in Preemies
Eye opening in premature babies is influenced by several factors, primarily gestational age at birth. Infants born before 26 weeks may have fused eyelids at birth, reflecting their developmental stage. For these infants, eyelids open within days or weeks after birth, often around what would have been 26 to 28 weeks of gestation.
The Neonatal Intensive Care Unit (NICU) environment also influences sensory development, including vision. Continuous bright lighting in the NICU can be challenging for preemies, as their pupillary light reflex may not be fully developed before 32 weeks. While early light exposure does not significantly impact visual development, it can contribute to visual pathway issues.
A baby’s overall health status and medical interventions can also impact eye development and opening. Retinopathy of prematurity (ROP), a common eye concern in preemies, involves abnormal blood vessel growth in the retina, which is still developing after early birth. The severity of ROP often correlates with the degree of prematurity, with extremely premature infants being at higher risk. Oxygen therapy can also influence the development of eye problems like ROP due to the sensitivity of underdeveloped retinal blood vessels to oxygen levels.
What to Expect and When to Seek Guidance
If a premature baby’s eyelids are fused at birth, they typically separate within an average of 5.5 days. Eyelid opening generally occurs between 25.5 and 26.5 weeks gestational age. For preemies, visual development often aligns with their corrected gestational age, which is their chronological age minus the number of weeks or months they were born early.
While most preemies open their eyes within this timeframe, variations occur. Parents should observe their baby’s eye development and seek guidance from a pediatrician or pediatric ophthalmologist if they notice signs like a prolonged delay in eye opening beyond the expected corrected gestational age.
Other signs warranting professional guidance include eye opening asymmetry, discomfort or irritation around the eyes, unusual eye movements, or any visible eye abnormalities. Medical evaluation helps identify and address underlying issues, supporting visual outcomes for the premature infant.
Supporting Sensory Development in Preemies
Supporting premature babies’ sensory development, including vision, involves a nurturing and controlled environment. Creating a calm atmosphere in the NICU and at home is beneficial.
Managing light exposure supports visual development, especially for babies born before 32 weeks whose pupillary light reflex is not fully developed. Cyclical lighting, mimicking natural day and night cycles, benefits preemies. This involves alternating controlled light and dimness, rather than continuous bright or dim lighting.
Gentle interaction and appropriate stimulation, without overstimulation, are important. For visual stimulation, simple high-contrast patterns like black and white cards can be introduced as preemies respond to sights. These engage their vision and support visual system development. Promoting quiet time and observing baby’s cues for interaction are also important.