Purpose: To observe the effect of a topical anesthetic on pain and corneal clarity in premature infants undergoing eye examinations for retinopathy of prematurity (ROP). Methods: ROP examinations were performed on premature infants who were randomized to receive either proparacaine 0.5% or an artificial tear solution in the right eye. All infants received an artificial tear solution in the left eye. Assessment of discomfort was performed by use of the Premature Infant Pain Profile (PIPP) during examination of the right eye, with a painful event defined as a PIPP score ≥11. The left eye was then examined and a comparison of corneal clarity was made between the 2 eyes. Results: A total of 39 examinations were performed on 34 infants: artificial tear solution was administered 17 times and topical proparacaine anesthetic 22 times. The mean PIPP score for those receiving artificial tears was 10.4 compared with 8.8 for the anesthetic group (p = 0.17). Of the examinations without anesthetic, 65% were painful, compared with 27% with anesthetic (p = 0.04). No effect on corneal clarity was observed in any examination. Conclusions: The use of a topical anesthetic appears to marginally decrease pain and has no adverse effect on subjectively assessed corneal clarity during examination of premature infants for ROP. Copyright © 2011 by the American Association for Pediatric Ophthalmology and Strabismus.