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

Purpose of review: This review summarizes recent advances in pediatric ophthalmic anesthesia, focusing on emergence agitation, examination under anesthesia (EUA), anesthesia strategies for retinopathy of prematurity (ROP), and care for children with developmental or medical comorbidities. Recent findings: Emerging evidence supports multimodal approaches to reduce emergence delirium, including sub-Tenon's blocks with dexmedetomidine and intraoperative methadone. EUA protocols now emphasize streamlined exams under a single anesthetic, with some low-risk cases managed without intravenous access or general anesthesia. In ROP care, alternative strategies such as laryngeal mask airway use and bedside laser under sedation are being explored. Concerns over neurodevelopmental risks are also prompting efforts to limit cumulative anesthetic exposure through coordinated care. Summary: Pediatric ophthalmic anesthesia is evolving toward safer, more individualized approaches. Incorporating targeted techniques and minimizing exposure can improve outcomes and inform best practices in this vulnerable population.