Ophthalmic surgery takes place in children of all ages, from premature neonates to teenagers, the majority of whom are ASA 1 or 2. In some cases, the ocular pathology may be part of a wider congenital or metabolic abnormality and anaesthesia is not so straightforward. Nearly all will require general anaesthesia. Anxiety can be common in children returning for repeated procedures, and premedication may be necessary. Surgery can be extraocular or intraocular. Simple day-case procedures can usually be managed with an inhalational spontaneous breathing technique and supraglottic airway device (SAD). Certain more complex cases necessitate a completely still eye, and muscle relaxation is therefore usually required. Special anaesthetic considerations are management of the oculocardiac reflex (OCR), commonly elicited by traction on the recti muscles and prevention of postoperative nausea and vomiting (PONV); strabismus surgery is particularly emetogenic. The majority of ophthalmic surgery is not particularly painful, and simple analgesia with paracetamol and NSAIDs is sufficient. Regional ophthalmic blocks, such as sub-Tenons, can supplement or offer an alternative to opiates when additional analgesia is required. This has the added advantage of producing akinesis of the globe and a beneficial reduction in PONV and the OCR.