Microphthalmia in children causes symptoms and treatment methods

Many parents are surprised after their baby is born to notice that the size of the eye doesn’t look normal, and the first question that comes to mind is: “Does my child have a problem?”
One of the most common conditions that can appear early is Microphthalmia (small eye) in children. This condition may have different causes—sometimes genetic, other times due to issues during pregnancy.Microphthalmia can affect the shape of the eye, vision, and even the child’s self-esteem as they grow up.???? In this Daleely Medical guide, we’ll explain the main causes of microphthalmia, the symptoms parents should look out for, how the condition is diagnosed, the latest treatment options (whether through exercises or surgery), and the most important tips to help your child live a normal and confident life.

❓ Frequently Asked Questions about Microphthalmia in Children

1. What is Microphthalmia?

Microphthalmia is a congenital condition where the eyeball is smaller than normal. It can affect one eye or both eyes.

2. Does Microphthalmia affect vision?

Yes. In most cases, vision is very weak or absent, but in some children there may be a small amount of usable vision.

3. What causes Microphthalmia?

Genetic factors.
Maternal infections during pregnancy, such as rubella or toxoplasmosis.
Exposure to harmful substances or medications during pregnancy.
Abnormal eye development in the fetus.

4. Can the small eye grow larger with time?

No. The eye does not grow to a normal size, which makes it different from temporary eye problems that may improve with age.

5. What are the treatment options?

Using eye expanders to prepare the socket.
Cosmetic artificial eye (ocular prosthesis).
Surgical procedures to enlarge the socket or adjust the eyelids.
Vision therapy and exercises if there is any remaining vision.

6. Do exercises cure Microphthalmia?

Exercises do not increase eye size, but they help strengthen eye muscles, stimulate any existing vision, and support coordination.

7. Is Microphthalmia genetic?

It can be genetic. That’s why doctors sometimes request genetic testing to confirm the cause.

8. Can the child live a normal life?

Yes ✅ With early treatment (especially cosmetic intervention) and family support, children can live a normal and confident life.

9. When should treatment begin?

The earlier the intervention (from the first months of life), the better the results for eye socket growth and facial symmetry.

10. Can surgery fail?

Like any surgery, there is a risk of partial failure or complications. However, regular follow-ups with a pediatric ophthalmic surgeon greatly reduce the risks.

11. Is Microphthalmia the same as eye atrophy (phthisis bulbi)?

No.

Atrophy: the eye is normal at birth but shrinks or loses function later.
Microphthalmia: the eye is small from birth (a congenital defect).

12. Can the small eye be replaced with a full artificial eye?

Yes, an artificial eye is used for cosmetic purposes to restore natural appearance, but it does not provide vision.

13. Does the artificial eye need replacement?

Yes ✅ As the child grows, the prosthesis must be replaced or adjusted to match facial bone development.

14. Is there a risk to the healthy eye?

No, the other eye is usually normal. However, it must be protected and checked regularly to avoid extra strain or injury.

15. What tests are needed for diagnosis?

CT scan or MRI to assess the eye and orbit size.
Genetic tests if a hereditary cause is suspected.

16. Can the child play sports?

Yes, but it’s best to avoid contact sports with strong facial impact (e.g., boxing).

17. Does it affect facial appearance?

Yes. A small eye may affect the growth of surrounding bones, which is why early socket expansion and cosmetic treatment are important.

18. Can the child be bullied?

Unfortunately, yes.
Solutions: early cosmetic treatment, family support, and boosting the child’s self-confidence.

19. Is Microphthalmia rare?

It’s not very common, but doctors are now more experienced in early diagnosis and management.

20. Is there a difference between one eye and both eyes being affected?

One eye: the child relies mostly on the healthy eye.
Both eyes: vision is often very weak or absent, making the condition more challenging.

Causes of Microphthalmia in Children

Genetic factors

Mutations in genes responsible for eye formation.
May appear as an isolated case or part of syndromes such as CHARGE or Walker-Warburg.

Problems during pregnancy

Maternal infections: rubella, toxoplasmosis, herpes.
Exposure to radiation, chemicals, or harmful drugs.

Fetal development disorders

Abnormal development of the neural tube or eye tissues.
Reduced blood supply or oxygen during pregnancy.

Associated eye conditions

Congenital retinal detachment.
Lens–cornea adhesion.
Corneal or lens opacity.

Unknown causes
Sometimes the condition is classified as unexplained congenital anomaly.

Symptoms of Microphthalmia in Children

Eye smaller than normal, visible compared to the other eye or peers.
Eye deformity: sunken or bulging appearance.
Poor vision (degree depends on severity).
Strabismus (squint) due to size or vision difference.
Frequent tearing or discharge (blocked tear ducts).
Sometimes linked to other developmental disorders.

Types of Microphthalmia

Mild Microphthalmia

Slightly smaller eye, sometimes unnoticed until later.

Moderate/Complex Microphthalmia

Smaller eye + other eye problems (corneal opacity, retinal issues, congenital glaucoma).

Severe Microphthalmia

Very small, underdeveloped eye with little or no vision.
Requires cosmetic or surgical intervention.

Partial Anophthalmia

Eye extremely small, almost absent.
Different from complete anophthalmia, but with similar vision loss.

Stages of Microphthalmia

Unlike diseases that progress, microphthalmia is classified into levels:

Stage 1 (Mild): Slightly smaller eye, near-normal vision possible.
Stage 2 (Moderate): Noticeably small eye, strabismus, reduced vision.
Stage 3 (Severe): Very small, incomplete eye, vision almost absent.
Stage 4 (Partial Anophthalmia): Eye extremely small, almost invisible, no vision.

Risks of Microphthalmia in Children

Vision loss: mild to complete blindness depending on severity.
Strabismus & amblyopia (lazy eye).
Psychological & social effects: bullying, low self-esteem.
Facial bone development issues: asymmetry due to poor orbital growth.
Associated syndromes: may come with brain, heart, or hearing problems.

Strabismus and Amblyopia (Lazy Eye)

Poor vision or a noticeable size difference between the eyes increases the risk of strabismus (crossed eyes).
Over time, the weaker eye may develop amblyopia (lazy eye), where the brain stops relying on it.

Psychological and Social Issues

The different eye appearance may lead to bullying or embarrassment.
This can affect the child’s confidence and social interactions.

Facial Growth Abnormalities

A small eye can impact the growth of the orbital bones (eye socket).
This may cause facial asymmetry.

Associated Conditions

Sometimes microphthalmia appears alongside other congenital problems, such as heart defects, brain abnormalities, or hearing loss (especially if it’s part of a genetic syndrome).
That’s why a child often needs care from a multidisciplinary team, not just an eye specialist.

Diagnosis of Microphthalmia in Children

Early diagnosis is crucial for planning treatment. Doctors use several methods:

Clinical Examination

The ophthalmologist compares eye size with normal measurements for the child’s age.
They examine the cornea, lens, retina, and eye movements.

Eye Measurement (Ultrasound – B-scan)

Ultrasound imaging accurately measures eye size.
It also detects internal abnormalities such as retinal detachment or lens opacity.

CT / MRI Scans

Used in severe or complex cases.
Shows details of the small eye, surrounding orbit, and bone structure.

Vision Testing

Depending on the child’s cooperation, simple tests are used to evaluate sight.
Continuous follow-up is essential to track any remaining vision.

Genetic Testing

Ordered if a genetic syndrome is suspected.
May include DNA tests, plus brain, heart, and hearing assessments.

Can Microphthalmia Be Treated with Medication?

❌ Currently, there are no eye drops or medications that make the eye grow normally, since the condition is congenital.

However, medications are used to manage complications:

Eye drops for glaucoma if present.
Anti-inflammatory drops or ointments.
Antibiotics for recurrent infections.
Glasses or contact lenses to improve remaining vision.

Surgical Treatment Options for Microphthalmia in Children

1. Orbital Expansion Surgery

Goal: enlarge the orbit and stimulate bone growth.
Method: gradually adjustable orbital expanders.
Done in stages with long-term follow-up.

2. Ocular Prosthesis (Artificial Eye)

Used when the eye is very small and has no vision.
Purpose: cosmetic improvement + maintaining facial bone growth.
Needs replacement as the child grows.

3. Orbital Implants (Silicone or Acrylic Expanders)

Placed in the socket instead of the small or absent eye.
Provides facial volume.
Later, a prosthetic eye can be fitted over it.

4. Eyelid Surgery

Corrects drooping or asymmetry of the eyelids.
Makes the small eye or prosthesis look more natural.

5. Vision-Preserving Surgeries (if partial sight exists)

Cataract removal.
Retinal detachment repair.
Glaucoma treatment.
Goal: preserve any remaining vision.

Causes of Surgical Failure in Microphthalmia

Despite generally good results, some surgeries may fail due to:

Poor response of orbital tissue or bones (orbit doesn’t expand properly).
Implant rejection (inflammation or implant displacement).
Healing complications (chronic infections, discharge, or tissue erosion).
Cosmetic issues (prosthesis not matching the other eye, eyelid asymmetry).
Growth-related changes (children outgrow implants/prostheses, requiring adjustments).

Possible Outcomes of Surgical Failure

Persistent cosmetic differences (asymmetry between eyes).
Facial bone growth abnormalities.
Chronic pain or infections.
Emotional frustration for both child and parents.

How to Reduce the Risk of Surgery Failure?

Choose an experienced pediatric oculoplastic surgeon.
Maintain regular follow-ups after surgery.
Replace prostheses or expanders as advised.
Follow post-op care instructions carefully.

Tips for Managing Microphthalmia in Children

Regular medical follow-up: with pediatric ophthalmologists; complex cases may need a geneticist and oculoplastic surgeon.
Adherence to treatment: use prescribed glasses, drops, or prosthesis care routines.
Early intervention: the earlier the treatment, the better the cosmetic and developmental outcomes.
Psychological support: reassure the child, prevent bullying, and seek therapy if needed.
Cosmetic care: prostheses and eyelid surgeries are essential for appearance and confidence.
Infection prevention: maintain hygiene of prostheses/implants; seek medical help if redness or discharge appears.
Prepare for adjustments with growth: changing prostheses or expanders as the child grows is normal, not a treatment failure.