Gut microbiota and pediatric eye diseases: current insights, mechanistic underpinnings, and future outlook

Background As a core component of the human microecosystem, the gut microbiota modulates systemic immune-inflammatory responses, metabolic homeostasis, and neural signal transmission via the gut-eye axis. Dysbiosis of the gut microbiota has been closely linked to the onset and progression of multiple ophthalmic disorders in adults. Childhood represents a critical window for both gut microbial colonization and maturation, as well as a formative period for ocular development and visual function establishment. Objective This review systematically examines the evidence connecting gut microbiota to several common pediatric ophthalmic diseases, including allergic conjunctivitis, myopia, retinopathy of prematurity, and postoperative inflammation following congenital cataract surgery. Methods We conducted a narrative literature review analyzing the potential mechanisms underlying the gut-eye axis, including immune regulation, microbial metabolite signaling, crosstalk between the intestinal barrier and blood-ocular barrier, and neural pathways. A comprehensive search of PubMed, Web of Science, and Scopus databases was performed for literature published from January 2000 to October 2025 using search terms related to gut microbiota and pediatric ophthalmic diseases. Studies were selected based on clinical relevance and contribution to understanding gut-eye axis interactions in pediatric populations. Results The review identifies emerging associations between gut microbiota dysbiosis and various pediatric ophthalmic conditions, with evidence supporting immune dysregulation, metabolite imbalance, and barrier dysfunction as potential mechanistic pathways. Conclusion Early disruptions to the gut microbiota may exert potential long-term effects on ocular health. This review aims to provide new insights into the etiology, early intervention, and precision management of pediatric ophthalmic diseases.