Cataracts in children

A cataract is a painless, cloudy area in the lens of the eye that blocks the passage of light to the retina, the nerve layer at the back of the eye, usually causing vision problems. Although cataracts are rare in children, they do occur in about 1 in 5,000 births.¹ The condition is usually present at birth and is more common in premature infants. It is often a result of genetics, infection during pregnancy, or low birth weight.

A child's vision develops rapidly in the first few months of life. If a cataract blocks light from entering the eye and stimulating the retina, the area of the brain used for sight does not develop properly. The child then never sees well with that eye (amblyopia), even if the cataract is later removed.

The signs of cataracts in children include the following:

• The child may not look directly at or respond to faces or large, colorful objects. An infant who cannot find small objects when he or she is crawling on the floor may have cataracts.
• The child may scowl, squint, or shield his or her eyes more than expected when in bright sunlight because of the glare caused by a cataract.
• The child's eyes may be misaligned and not focus on the same point at the same time (strabismus).
• The affected eyes may have repetitive wandering movements (nystagmus). This is usually a later sign of cataracts and may not develop until the infant is several months old. Removing the cataract will probably not correct all of the vision loss at this point.

If a child has a cataract in only one eye, you may not be able to tell. All children should have regular examinations by a family doctor to screen for these types of cataracts.

Cataracts in infants are commonly detected at birth or during routine well-child checks. More frequent exams are needed if the child has a medical condition that increases the risk of developing cataracts, if he or she seems to have trouble seeing, or if you notice your child has clouding of the lens. For example, in a photograph of the child, one eye may appear white, whereas the other has the normal "red eye" reflex.

For children who have vision problems due to cataracts, surgery is usually needed to prevent permanent vision loss and assure normal vision development. The critical period for eyesight development is from birth to about 3 months of age. Vision problems during this period can disrupt normal development of sight. The earlier cataracts are diagnosed and treated in children, the more likely it is their sight will be preserved or develop normally.

A small number of adults and children with cataracts may benefit for a short time from eyedrops that widen (dilate) the pupil. These eyedrops increase the amount of light getting into the eye. They may also be used in children under age 2 who have cataracts to prevent loss of vision until surgery can be done.

Some types of cataracts in children require more urgent treatment than others:

• Large, dense cataracts present from birth in the middle of the lens that affect only one eye are more likely to cause permanent vision loss. These cataracts need early diagnosis and will most likely need to be removed promptly.
• Smaller cataracts that are not causing significant vision loss and are in only one eye may be treated by patching the good eye. This strengthens sight in the eye with the cataract. Eyedrops that enlarge (dilate) the pupil may also be used to increase the amount of light getting into the eye. These treatments may prevent loss of vision until surgery can be done, if surgery is necessary.
• Cataracts present from birth that cover only part of the lens and that are in both eyes are least likely to cause blindness. These cataracts may only need to be checked often by an eye specialist (ophthalmologist) to see whether they are getting larger.

Call your child's doctor if:

• Your baby does not look directly at or respond readily to faces or large, colorful objects by age 2 to 3 months.
• Your child scowls, squints, or shields his or her eyes more than expected when in sunlight, or light seems to hurt your child's eyes.

Citations

1. Madan A, Good WV (2005). Disorders of the eye. In HW Taeusch et al., eds., Avery's Diseases of the Newborn, 8th ed., pp. 1539–1555. Philadelphia: Elsevier Saunders.