Growth and

Development
of the Eye
ELMER LUIGI B. LOZADA JR., MD
TOPIC OUTLINE
1. AXIAL LENGTH 6. EXTRAOCULAR MUSCLES
2. ORBIT AND ADNEXA 7. RETINA
3. CORNEA 8. REFRACTIVE STATE
4. IRIS AND PUPIL 9. IOP
5. LENS 10. ABNORMAL GROWTH AND
DEVELOPMENT
AXIAL LENGTH
- Most of the growth of the eye takes
place in the first year of life
- 3 phases:
1. First phase (birth to 2 years old)-
rapid growth
2. Second phase (2-5 years old)
3. Third phase (5-13 years old)-growth
slows
 ORBIT AND ADNEXA
▪ orbital volume increases
▪ becomes less circular, resembling a horizontal
oval
▪ palpebral fissure measures approximately 18
mm horizontally and 8 mm vertically at birth
▪ lacrimal fossa becomes more superficial
▪ angle formed by the axes of the 2 orbits less
divergent
CORNEA
Age Keratometry Values
▪ corneal diameter increases rapidly during the
Birth 52D
first year of life. (ave: 9.5–10.5 mm in
newborns and increases to 12.0 mm in adults) 6 months 46D
12 months 42-44D
▪ Flattens in the first year; keratometry findings
changes rapidly Age CCT
▪ Becomes thinner 32 weeks AOG 691 μm
Birth 564 μm
▪ Corneal endothelial cell density decreases
6th to 12 months 541-545 μm
proportional to increase in corneal diameter
1 year old 553 μm
as cells migrate to cover a larger surface area.
12 years old 573 μm
IRIS AND PUPIL
▪ Iris color occur over the 1st 6th to 12th MOL

▪ Iris pigmentation increases in the first 1 to 2

years after birth, with eye color stabilizing at
around age 2 years

▪ Pupil diameter less than 1.8 mm or greater than

5.4mm can be considered abnormal

▪ Pupillary light reflex observed at 31 weeks AOG

LENS
▪ power of the pediatric lens
decreases dramatically over the
first several years of life
▪ power decreases from
approximately 35.00 D at birth to
about 23.00 D at age 2 years
▪ power 19D by 11yo with little to no
change after
EXTRAOCULAR MUSCLES
• Rectus mm of infants are smaller than of
adults
• Insertions are 2-3mm narrower and
tendons are thinner
• Newborn: distance from rectus muscle
insertion to limbus is 2mm less than
adults
• 6 months: 1mm less than adults
• 20 months: adult dimension
EXTRAOCULAR MUSCLES
• Vestibular-ocular system starts at 34 weeks
AOG
• Conjugate horizontal gaze is present at birth
but vertical may be fully functional at 6
months
• Intermittent strabismus occurs in 2/3 of
young infants but USUALLY resolves by 2-3
months
• Accommodation and fusional convergence
3 months
RETINA
1. Macula is poorly developed at birth but
changes rapidly during the first 4 years
2. Macular pigmentation, development of
foveal reflex are the most significant changes
3. Improvement in visual acuity with age is due
in part of development of macula
▪ Cone differentiation, narrowing of rod-
free zone and increase in foveal cone
density
RETINA
• Retinal vascularization starts at optic
nerve head at 16 weeks of gestational
age and proceeds to the peripheral
retina, reaching the temporal ora
serrata by 40 weeks of gestational
age.
REFRACTIVE STATE
1. Eyes are usually hyperopic at birth and becomes more hyperopic until 6-8 years old
then,
2. Myopic shift until reaching adult dimensions, usually by about 16 years of age
3. Emmetropization- changes in the refractive power of the anterior segment and axial
length
4. Race and ethnicity: Myopia (Asian); Hyperopia (white); astigmatism (Hispanic and
African American)
REFRACTIVE STATE
Myopia increasingly prevalent worldwide
▪ develops before age 10 years, there is a higher risk of eventual progression to myopia of
6.00 D or more
▪ urbanization, increased near work, and decreased exposure to ultraviolet light are
suggested influences
▪ suggestions:
• increased outdoor activities
• topical low dose atropine
• multifocal contact lenses OR orthokeratology
INTRAOCULAR PRESSURE
•Normal IOP is lower in infants than in
adults
•CCT influences the measurement of
IOP, but this effect is not well
understood in children.
ABNORMAL GROWTH AND
DEVELOPMENT
ABNORMAL GROWTH AND
DEVELOPMENT
HIGHLIGHTS
• Axial length increases by approximately 3 mm between birth and 1 year of age.
• The eye becomes slightly more hyperopic until 6–8 years of age, followed by a
myopic shift toward emmetropia.
• Childhood myopia is increasingly prevalent; increased outdoor activities and
lowdose atropine can decrease myopic progression in some children.
THANK YOU FOR YOUR KIND
ATTENTION!

ELMER LUIGI B. LOZADA JR., M.D.