Is the ROP Eye Screening Exam Painful for Newborns?

Yes, the Retinopathy of Prematurity (ROP) screening exam is uncomfortable and stressful for medically vulnerable infants, and it is very common for them to cry during the procedure ^[1]. Watching your baby go through this bedside exam is a major source of anxiety for many parents. However, these exams are necessary because ROP can develop without obvious outward symptoms; screening detects retinal changes early, when treatment may protect your baby’s vision.

While the exam is distressing, NICU care teams use a combination of pain management strategies to keep your baby safe and reduce their discomfort ^[2]. Understanding what happens before, during, and after the exam can help you know what to expect and how to advocate for your baby’s comfort.

Before the Exam: Preparation and Drops

About an hour before the exam, the nurse will place pupil-dilating drops into your baby’s eyes, which may briefly sting. Right before the doctor begins, they will use pain-management tools to help soothe your baby ^[2]:

• Numbing Drops (Topical Anesthetics): The doctor places anesthetic drops (like proparacaine) directly into the baby’s eyes. These can reduce pain from contact with the eye’s surface, though they do not eliminate the feeling of pressure, stretching, or the infant’s overall stress ^[3][4].
• Oral Sucrose and Pacifiers: A few drops of a medical-grade sugar water solution (sucrose) may be placed on the baby’s tongue. The sweet taste, combined with sucking on a pacifier (non-nutritive sucking), may reduce observed pain scores and help soothe some infants ^[5][4].
• Swaddling and Facilitated Tucking: Keeping a baby securely wrapped, or having a nurse gently hold their arms and legs in a curled, fetal position (facilitated tucking), provides physical containment that can lower stress responses ^[6][7].

Stronger systemic pain medications (like oral morphine or intravenous fentanyl) are generally not used routinely for a brief screening exam because of the risk of serious breathing difficulties ^[8]. However, analgesia decisions always depend on the baby’s individual medical condition and the NICU’s specific protocols.

During the Exam: The Procedure and Monitoring

The pediatric ophthalmologist needs a clear, wide view of the retina at the back of the eye. Several parts of this process cause distress:

• Restraint: Babies naturally dislike being held still. A nurse or doctor must gently hold the baby’s head steady to perform the exam safely.
• The Speculum: The doctor uses a small, specialized instrument called a speculum to hold the eyelids open. The pressure and stretching from this tool are primary sources of physical discomfort ^[9].
• The Scleral Depressor: The doctor may use a small tool to gently press on the outside white layer of the eye (scleral indentation). This rotates the eye slightly so they can see the far edges of the retina, but the pressure is uncomfortable ^[9].
• Bright Lights: An ophthalmoscope shines a very bright light into the eye. Because the pupils are dilated and the eyelids are held open, increased light enters the eye, which is highly irritating ^[10].

Monitor Alarms: You may notice your baby’s monitors alarming during the procedure. ROP exams can cause transient changes in heart rate, breathing, and oxygen saturation ^[11][12]. The medical team watches these vital signs continuously; they will pause the exam if needed and respond to any persistent or significant changes.

After the Exam: Recovery and Comfort

The active part of the eye exam is usually brief. Once the instruments and bright lights are removed, many infants settle over minutes to hours, though recovery varies depending on the baby’s age and health ^[7][13]. Some babies may remain fussy, sensitive, or extra sleepy for several hours after the exam ^[1].

Your baby will continue to be monitored closely. The clinical team will watch for ongoing irritability, apnea (pauses in breathing), bradycardia (slow heart rate), or oxygen desaturation ^[1][12]. Providing comfort care after the exam—such as quiet time, gentle touch, or kangaroo care (skin-to-skin contact, if your baby is medically stable and the NICU approves it)—may help your baby settle ^[14]. Note that it is completely acceptable to step out of the room during the exam if watching is too distressing; you can always ask the nurse to explain what happened and reunite with your baby for comfort care afterward.