Congenital Cataracts in Babies and Children

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It is a common belief that cataracts only occur in the eyes of older people. However, babies and children can be born with cataracts, or they may develop them as they age. A congenital cataract causes the same symptoms as adult cataracts—a clouding in the lens of the eye that can cause blurry vision or blindness.

Located behind the iris of the eye, the lens is normally clear and allows incoming light to clearly focus an image on the retina. If a cataract develops, the lens becomes cloudy, causing images to become blurred and distorted.

Symptoms

Cataracts aren't always visible. However, if your child is older, they may complain of certain visual symptoms that should alert you to a possible cataract. The following symptoms may signal a cataract and should be reported to your child's doctor:

  • Cloudy vision
  • Blurry vision
  • Decreased vision
  • Double vision
  • Lights that appear too bright
  • Colors that appear faded

If your baby or child is very young, they will not be able to complain about symptoms. If you notice a white or gray spot on your child's pupil, it could be a cataract. Try shining a flashlight into your child's eyes. A cataract sometimes causes the pupils to appear white. Keep in mind that a cataract can sometimes appear in only one eye.

You may be able to spot a cataract by your child's actions. For example, a child with a cataract may not look directly at someone's face or other large objects in their view. Also, they may squint heavily and try to shield their eyes when exposed to bright sunlight. You may also notice a misalignment of your child's eyes or repetitive movements of the eyes. Some parents have been alerted to cataracts in their children's eyes when looking at photos. Instead of seeing "red eye" in pictures, a cataract might appear as a "white eye."

If you think your child may have a cataract, it's very important to tell your pediatrician. Early treatment can reduce the possibility of long-term vision problems.

Causes

Cataracts can be hereditary. Some infants are born with cataracts, known as congenital cataracts. These cataracts may develop because of certain infections, metabolic problems, diabetes, trauma, inflammation, or drug reactions.

Some antibiotics used to treat infections in pregnant women may cause cataracts in newborn babies. Cataracts may form during pregnancy if a mother develops infections such as measles or rubella, chicken pox, cytomegalovirus, herpes simplex, herpes zoster, poliomyelitis, influenza, Epstein-Barr virus, syphilis, or toxoplasmosis. Sometimes congenital cataracts are caused by chromosomal problems such as Down syndrome.

Some children develop cataracts during the first few years of life. Trauma to the eye, such as a strong blow to the eye, can sometimes lead to a cataract. Sometimes a cataract is missed during infancy and babyhood but discovered in an older child.

What Causes Cataracts?

Diagnosis

Most pediatric cataracts are detected shortly after birth when an infant is examined before leaving the hospital. Some are detected by pediatricians during well-baby exams. Sometimes congenital cataracts can go unnoticed for years, mainly because young children do not usually recognize problems with their vision. However, parents may become suspicious of a problem when their child seems overly sensitive to bright lights or appears to struggle with focusing.

Once alerted to a possible problem, an eye doctor will conduct a thorough eye exam on the child. The exam will include a slit lamp examination of both eyes, checking intraocular pressure, and other in-office tests and procedures. The doctor will be able to diagnose a cataract in one or both eyes depending on clinical test results.

Tests to Diagnose a Cataract

Treatment

Treatment for pediatric cataracts varies depending on the type and severity of the cataract. Most children with cataracts will require surgery to remove it. In most cases, cataracts should be removed as early as possible, even during the first weeks of an infant's life. Children who undergo cataract surgery usually experience very little pain or discomfort.

The surgical procedure for removing a cataract in a baby or young child is done with the child under general anesthesia. Because their eyes are so much smaller than an adult's eyes, the surgery involves using specialized surgical instrumentation and special techniques. The surgeon will first break up the lens into small pieces with a special instrument. The pieces will then be removed through a small incision.

Although a delicate procedure, cataract removal is generally safe when performed by an experienced, pediatric eye surgeon. Common risks of cataract removal, though rare, include glaucoma, retinal detachment, infection, and the need for more surgeries.

After surgery, steps must be taken to rehabilitate the eyes and vision. Treatment will be needed in order to repair and restore eye-brain connections needed for clear vision. In a sense, the eyes will need to re-taught how to focus properly. Eye doctors use the following techniques to restore focusing power in children:

  • Contact Lenses: Contacts are used after surgery in children under 2 years of age, since the eye and focusing power change rapidly during the first years of life. Contact lenses can also be used in older children if needed. Most children adapt to wearing contact lenses rather quickly.
  • Intraocular Lenses: Intraocular lenses are artificial lenses that can be implanted in place of natural lenses in young children. Children won't be able to feel the lens inside the eye.
  • Glasses: Children may be fitted with eyeglasses when both eyes were affected by cataracts. Glasses can also be used in addition to contact lenses or intraocular lenses, as focusing restoration needs to be managed carefully for the child's future vision.

If amblyopia (lazy eye) develops after surgery, eye patching may be required. Patching involves covering the good eye to stimulate vision in the eye that had the cataract removed.

Learn About Treatment Options for Cataracts

A Word From Verywell

Treating cataracts in early childhood is extremely important for a child's future vision. The critical period for vision development is during the first few months of life, as an infant's brain develops vision in response to clear images. The brain will set up abnormal visual connections if vision is blurry or distorted because of cataracts. Timely treatment in a young child will have good results, although clear vision may require years of visual rehabilitation.

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