Congenital Cataracts

The lens of the eye, which is normally clear, becomes cloudy, preventing light from focusing properly on the retina.

Congenital cataracts can occur in one or both eyes.

Early diagnosis and treatment are crucial to prevent visual impairment.

White or gray pupil: The most noticeable sign, sometimes first seen as a missing red reflex in one eye on a flash photograph.

Poor vision: The child may not follow objects or make eye contact.

Nystagmus: Abnormal, involuntary eye movements, usually bilateral and a sign of long-standing poor vision.

Sensitivity to light: The child may squint or avoid bright lights.

Strabismus (crossed eyes): Misalignment of the eyes due to poor vision.

Lack of interest in faces and toys compared with what is expected for the baby's age.

Family history of cataracts or genetic mutations.

Associated with syndromes like Down syndrome or Lowe syndrome.

Maternal infections such as rubella, toxoplasmosis, or cytomegalovirus.

Conditions like galactosemia or diabetes.

Eye injuries during or after birth.

Exposure to radiation or certain medications during pregnancy.

In some children no clear cause is found, which is never a reason to delay treatment.

Newborn eye screening: The red reflex test is the key step and should be performed in every newborn.

Pupil examination: A white or gray pupil may indicate cataract.

Imaging tests: Ultrasound becomes essential when the retina cannot be seen behind the cataract.

Assessment of cataract type and density: Whether it blocks the visual axis determines the decision to operate.

Biometry: Axial length and corneal measurements are needed for intraocular lens planning.

Systemic evaluation: Metabolic disease or congenital infection is investigated together with the relevant specialties.

The cloudy lens is removed and, in suitable cases, an artificial intraocular lens is implanted.

Surgery is typically performed within the first months of life; a dense cataract blocking the visual axis brings the timing forward further.

In very young infants the eye is still growing, so a lens implant may be deferred. Vision is then supported with a contact lens or glasses, and implantation is reconsidered at an older age.

Surgery is performed under general anaesthesia. When both eyes are affected, they are usually operated in separate sessions.

After surgery, glasses or contact lenses help the child focus.

Contact lenses are often preferred for infants.

Because the eye loses its focusing ability once the lens is removed, this correction is not optional; it is the continuation of the surgery.

If one eye is weaker, patching the stronger eye improves vision in the weaker eye.

In unilateral cataract this step matters as much as the operation itself. Surgery clears the lens; patching develops the vision.

Patching hours depend on age and on the difference in acuity, and are revised at each visit.

Drops are used regularly in the first days, and measures are taken to stop the child rubbing the eye.

Visits are frequent in the first weeks, then less often, but they never stop entirely.

Intraocular pressure is checked at every visit. Glaucoma can develop years after childhood cataract surgery, so follow-up continues with child glaucoma in mind.

The prescription changes as the eye grows, so glasses or contact lenses are updated regularly.

Clouding of the posterior capsule over time is common and is dealt with when needed.

Strabismus may develop; see strabismus in children.

Early diagnosis is critical to the outcome.

Regular follow-up monitors ocular development after surgery.

Family involvement: Inserting contact lenses and running patching therapy happen at home.

Vision rehabilitation programmes support the development of visual skills.

Patience: Vision develops over months of consistent treatment, not the day after surgery.

A white or grey appearance of the pupil.

Absent red reflex in one eye on a flash photograph.

A baby who does not follow faces or objects, or make eye contact.

Nystagmus or a newly appearing deviation.

A family history of childhood cataract.

Seek care promptly for any abnormal appearance of the pupil.

Follow instructions closely through surgery and aftercare.

Use play and educational activities to support visual development.

Keep follow-up appointments even when the child seems to be seeing well.