Eye and ear problems in premature babies

Premature babies are babies who are born at 37 weeks or earlier. Since a normal pregnancy lasts about 40 weeks, premature babies have less time to develop in the womb, making them more susceptible to health complications and defects. Some of the possible problems that may affect premature babies include vision and hearing impairment. The final stages of vision and hearing development occur in the last few weeks of pregnancy. Premature babies are at an increased risk for eye and ear problems.

If your baby is born prematurely, knowing the possible issues related to vision and hearing can help you seek the appropriate treatments.

Types of eye problems

The eyes develop the most during the last three months of pregnancy. This means that the earlier a baby is born, the more likely they are to experience eye problems. Many eye issues stem from an abnormal development of blood vessels, which can lead to vision impairment. While the eyes might look normal, you may notice that a baby doesn’t respond to objects or changes in light. These abnormalities may be signs of a vision problem or an eye defect.

Retinopathy of prematurity (ROP)

Retinopathy of prematurity (ROP) is a relatively common problem in premature babies. According to the National Eye Institute, ROP is most prevalent among babies born at 31 weeks or earlier. The eye disease develops when blood vessels grow abnormally in the eye. This is more likely to occur in premature babies because early delivery disrupts normal blood vessel growth. This causes abnormal vessels to form in the retina.

The retina is the layer of tissue at the back of the eyeball. It may become damaged if the abnormal blood vessels begin to swell and leak blood. When this happens, the retina can detach from the eyeball, triggering vision problems. In some cases, it can even lead to blindness.

Other potential complications of ROP later in life include:

  • crossed eyes
  • nearsightedness
  • farsightedness
  • lazy eye
  • glaucoma


Blindness is another possible complication associated with premature birth. Sometimes, ROP causes it. ROP can cause the retina to detach from the eye. If the detachment goes undetected, it can lead to blindness. Complications from ROP usually don’t occur until later in childhood.

Other cases of blindness in premature babies are separate from ROP. Some babies are born without certain parts of the eye, such as the eyeball or iris, resulting in vision loss. These conditions are very rare and not necessarily more common in premature babies.

Types of ear problems

Ear problems can also occur in premature babies. Some babies might have both hearing and vision impairment. Others may have hearing issues without vision problems. Hearing loss and hearing difficulties are among the most common concerns. Physical abnormalities of the ears can also affect premature babies.

Congenital hearing loss

Congenital hearing loss refers to hearing problems that are present at birth. These issues may affect one ear or both ears, causing either partial or complete deafness. Hearing loss in babies is most often the result of a genetic defect. However, the risk for hearing impairment is greater in premature babies. This is especially the case if the mother has an infection during pregnancy.

Physical abnormalities

Physical abnormalities of the ears aren’t as common as hearing loss in premature babies, but they can occur. These may arise from an underlying health issue. Rarely, medication exposure during pregnancy can cause physical abnormalities of the ears in premature babies.

The following are possible ear abnormalities that may affect babies:

  • shallow depressions around the ear
  • skin tags, which can appear in the inner and outer parts of the ear
  • malformations of the ear, which are usually caused by chromosomal issues

Diagnosing eye and ear problems

All newborns get hearing screens at birth. However, premature babies might have further testing to detect possible issues.

An ophthalmologist is an eye doctor who specializes in diagnosing and treating vision problems as well as eye diseases. The ophthalmologist will check your baby’s vision and perform tests to check for signs of ROP.

An audiologist can also examine your premature baby if they don’t pass their hearing exam. They specialize in diagnosing and treating hearing disorders. The audiologist can conduct further tests to detect hearing problems in your baby.

Treating eye and ear problems

Treating eye problems

ROP in most babies doesn’t require treatment. You can follow up with an ophthalmologist after your baby comes home, however.

More severe cases of ROP may be treated using:

  • cryosurgery, which is a procedure that involves freezing and destroying abnormal blood vessels in the retina
  • laser therapy, which is a type of therapy that uses powerful light beams to burn and eliminate abnormal vessels
  • a vitrectomy, which is a surgery that’s done to remove scar tissue from the eye
  • scleral buckling surgery, which consists of placing a flexible band around the eye to prevent retinal detachment
  • surgery to repair complete retinal detachment

Your doctor can treat a missing eye using surgical implants when your child gets older.

Treating ear problems

Surgery is usually done to correct problems with the formation of the ear. Placing a cochlear implant in the ear may be done for hearing loss. A cochlear implant is a small electronic device that does the work of the damaged parts of the ear. It helps to restore hearing by providing sound signals to the brain.

Your child’s doctor may also recommend:

  • hearing aids
  • speech therapy
  • lip reading
  • sign language

What is the outlook?

All babies go through a series of screening tests soon after birth, regardless of how early or late they’re born. However, these tests are especially important for premature babies because they’re more likely to experience complications. Your doctor might be able to detect problems right away and to provide some specific recommendations for short-term and long-term care.

The risk for eye and ear problems varies significantly among premature babies. The earlier a baby is born, the more likely they are to have these issues. Early detection is critical for resolving vision and hearing impairment. It’s important never to disregard these concerns because some issues can get worse over time. While treatments also vary in how successful they are, early intervention can resolve most eye and ear problems.