Objective To evaluate the effect of dexmedetomidine (Dex) combined with esketamine on enhanced recovery after pediatric ophthalmology surgery under general anesthesia. Methods A total of 150 children who underwent pediatric ophthalmology surgery under general anesthesia at the Central Hospital of Kaifeng from April 2022 to August 2023 were selected. According to the random number table method, they were divided into three groups: a control group (group M, n=48), an observation group 1 (group S, n=53), and an observation group 2 (group Y, n=49). For anesthesia induction, group M followed traditional method, group S was administered with esketamine, while group Y received a combination of Dex and esketamine. Then, their general information was recorded, and mean arterial pressure (MAP), heart rate, and respiratory rate (RR) were recorded upon entering the anesthesia preparation room (T0), immediately at the start of surgery (T1), 5 min after the start of surgery (T2), 10 min after the start of surgery (T3), and at the end of surgery (T4). Furthermore, intraocular pressure was measured in the left and right eyes at 7 AM on the day of surgery and after the completion of anesthesia induction. The time to laryngeal mask removal, time to emergence, time to recovery of cognitive function, time to recovery of orientation, and the length of hospitalization stay were recorded. Results There were no statistical differences in general information among the three groups (all P>0.05). Compared with those at T0, group M showed decreases in MAP and heart rate at T1 to T4, group S presented increases in MAP and heart rate, and decreases in RR at T1 to T4 (all P<0.05), while in group Y, RR decreased at T1 to T4. Compared with group M, MAP and heart rate were reduced in groups S and Y at T1 to T4 (all P<0.05). Compared with group S, MAP and heart rate were reduced in group Y at T1 to T4 (P<0.05). Compared with those at 7 AM on the day of surgery, intraocular pressure in the left and right eyes of group M decreased after anesthesia induction (all P<0.05), while intraocular pressure increased in groups S and Y after anesthesia induction (all P<0.05). Compared with group M, intraocular pressure in groups S and Y increased after anesthesia induction, while group Y had lower intraocular pressure than group S after anesthesia induction (all P<0.05). Compared with group M, group S presented decreases in time to emergence, and time to recovery of cognitive function, time to laryngeal mask removal, time to orientation recovery and the length of hospitalization stay (all P<0.05); group Y showed decreases in time to emergence, and time to recovery of cognitive function, time to laryngeal mask removal, time to orientation recovery and the length of hospitalization stay (all P<0.05). Compared with group S, group Y showed reduced time to laryngeal mask removal, time to emergence, time to recovery of cognitive function, time to recovery of orientation, and decreased length of hospitalization stay (all P<0.05); while group Y had shorter times for laryngeal mask removal, recovery, cognitive function recovery, orientation recovery, and hospital stay (all P<0.05). There were no statistical differences in other indexes (all P>0.05). Conclusions The combination of Dex and esketamine exhibits good anesthetic effect in child patients after pediatric ophthalmology surgery under general anesthesia and can be safely and effectively used to promote rapid recovery.