The assumption that eye diseases develop in isolation from gut biology is increasingly untenable — and in children, where both the microbiome and visual system are still maturing, the overlap may have meaningful clinical consequences. A narrative review published in Frontiers in Nutrition synthesizes evidence connecting gut microbial dysbiosis to four pediatric ophthalmic conditions: allergic conjunctivitis, myopia, retinopathy of prematurity, and post-surgical inflammation following congenital cataract repair.
The proposed mechanistic architecture involves four interlocking pathways: immune regulation via gut-associated lymphoid tissue, signaling by microbial metabolites such as short-chain fatty acids, structural crosstalk between the intestinal barrier and blood-ocular barrier, and autonomic neural transmission through the gut-brain-eye axis. The review drew on literature spanning 2000–2025 from PubMed, Web of Science, and Scopus, and specifically focuses on childhood as a critical developmental window when microbial colonization patterns and visual function are simultaneously being established.
This synthesis occupies an interesting niche in the expanding gut-eye axis literature, which has mostly centered on adult conditions like age-related macular degeneration, glaucoma, and diabetic retinopathy. The pediatric focus adds nuance: early-life dysbiosis — driven by cesarean delivery, formula feeding, antibiotic exposure, or dietary patterns — may create inflammatory or metabolic milieus that prime susceptibility to these specific conditions during sensitive developmental periods. That said, this is a narrative review rather than a systematic meta-analysis, meaning study selection was not exhaustive or statistically pooled, and most underlying evidence remains associative rather than causal. Animal models and small clinical cohorts dominate the cited literature. The inclusion of myopia is particularly timely given its global epidemic trajectory in children, though direct microbiome-to-axial-length causation remains speculative. Overall, this review is best characterized as a thoughtful hypothesis-generating synthesis rather than a paradigm shift — useful for researchers designing mechanistic trials and clinicians curious about integrative approaches to pediatric eye health.
