Cataracts, childhood

Page last reviewed: 13/07/2011

Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make vision blurred or misty. They can develop in one or both eyes, and one eye can often be more affected than the other.

The lens

The lens is normally clear. It allows light to pass through to the back of the eye. If parts of the lens become cloudy (opaque), light cannot pass through the cloudy patches.

Over time, these cloudy patches usually become bigger, and more of them develop. As less light is able to pass through the lens, vision may become blurry or cloudy. The cloudier the lens becomes, the more sight will be affected.

How common are childhood cataracts?

Cataracts in babies and older children can be classified as:

  • congenital cataracts: cataracts that are present when a baby is born or shortly afterwards
  • developmental, infantile or juvenile cataracts: cataracts that are diagnosed in older babies or children

Childhood cataracts are very rare, affecting about three children in every 10,000.

Age-related cataracts

Cataracts are most commonly found in older people. These are called age-related cataracts.

Outlook

In babies and children, cataracts can be mild, and often have little or no effect on their vision. However, they can also slow down or stop the normal development of sight during childhood. Severe childhood cataracts that are not treated can sometimes cause irreversible damage to eyesight, including blindness.

Surgery can be performed to remove the cloudy lens and replace it with an artificial lens. Glasses will often need to be worn after the operation, or a patch may have to be worn in order to strengthen the vision in the weaker eye. Most children with childhood cataracts live a full and normal life. 

Lens
The transparent structure at the front of your eye, just behind your pupil (the black circle in the centre.

Page last reviewed: 13/07/2011

The symptoms of childhood cataracts can vary. For example, the symptoms can depend on:

  • how opaque (cloudy) the lens is
  • where the cloudiness is in the lens
  • whether one or both eyes are affected

A cloudy lens

The pupils are the black circles in the middle of each of your eyes. The lens is the transparent structure that is located behind the pupil.

If a baby has a cataract, the pupil in their eye may look white or cloudy. Sometimes, it may be possible to see the cloudiness without using special equipment, such as an ophthalmoscope (a medical instrument with a light on the end that produces a magnified image of your eye).

Mild cataracts may not affect the vision, or affect it only slightly. The cloudier the lens, the more your child's sight will be affected.

Severe cataracts can make your child's vision blurry or cloudy. If a baby has severe cataracts in both eyes, they may not seem to see or be aware of what is going on around them.

The position of the cataracts can also affect vision. For example, cataracts that are towards the centre of the lens may affect the vision more than cataracts that are towards the side of the lens.

Identifying symptoms

It can sometimes be difficult to identify the symptoms of cataracts in babies and children. Even older children may not realise that there is anything wrong with how they see, as they do not know any different.

For example, if a child has a cataract in one eye, they may not notice that the vision in this eye is poor, because they rely on the vision in their other eye.

If a child has cataracts in both eyes, one eye may be affected more severely than the other. This can cause the brain to learn to rely on the stronger eye. As a result, the weaker eye stops working as hard and its vision becomes poorer.

Other eye conditions

Children who have cataracts sometimes have other eye conditions as well. For example, they may have:

  • microphthalmia: abnormally small eyes
  • nystagmus: rapid uncontrolled eye movement

 

 

Lens
The transparent structure at the front of your eye, just behind your pupil (the black circle in the centre).

 

Page last reviewed: 13/07/2011

In many cases, it is not possible to determine the cause of childhood cataracts. However, some possibilities are:

  • genetic conditions 
  • infections during pregnancy

These are explained in more detail below.

Genetic conditions

Cataracts that are present from birth can be caused by genetic conditions. These are conditions that affect your genes (the units of genetic material that determine many of your body's characteristics) and can be inherited (runs in the family).

Cataracts can also be associated with conditions that are caused by chromosome abnormalities, such as Down's syndrome (a genetic disorder that affects your physical appearance, as well as your ability to learn and develop mentally). Chromosomes are the parts of the body's cells that carry the genes.

Infections

Cataracts that are present from birth can also be caused by infections caught by the mother during pregnancy. The most common infections include:

  • rubella (German measles): an infectious disease that is caused by a virus
  • toxoplasmosis: a condition that is contracted from eating uncooked meat, or from coming into contact with contaminated soil or cat's faeces
  • cytomegalovirus: a common virus that is part of the herpes family of viruses
  • chickenpox: a mild but highly infectious condition that is caused by a virus

Other causes

Cataracts that are present from birth can also be linked to other eye conditions including:

  • retinopathy of prematurity: a condition found mainly in babies who are born before week 37 of pregnancy
  • aniridia: a rare condition where the iris (the coloured part of the eye) is not formed properly

Conditions that affect the metabolism (the process that turns food into energy) can sometimes cause cataracts to develop in older babies or children, although these are rare. For example:

  • galactosaemia: when the sugar galactose (which mainly comes from lactose, the sugar in milk) cannot be broken down by the body 
  • diabetes: a chronic (long-term) condition that is caused by too much glucose in the blood 

Eye injuries can also cause cataracts sometimes.

 

 

Lens
The transparent structure at the front of your eye, just behind your pupil (the black circle in the centre).

Genetic
Genetic is a term that refers to genes. Genes are the characteristics inherited from a family member.

 

Page last reviewed: 13/07/2011

It is important that congenital cataracts (cataracts you are born with) are diagnosed as early as possible, ideally during the first few weeks after a baby is born. This will reduce sight loss.

Screening of newborn babies

In Ireland the parents of newborn babies are offered two full physical examinations for their babies:

  • the first within 72 hours of the baby's birth 
  • the second when the baby is about six to eight weeks old

Congenital cataracts are one of the conditions that are screened for in these examinations.

The healthcare professional who is screening your baby will look at your baby's eyes to check their general appearance and how they move. If your baby's eye looks cloudy, it could be a sign that they have cataracts.

Sometimes, it can be difficult to check the eyes of newborn or very young babies. This may be because:

  • their eyelids are swollen
  • their eyes are closed
  • they are unsettled, anxious or irritated

Even though cataracts may be present from birth, sometimes they are not diagnosed until the baby or child is older.

Checking children's eyes

If is thought that your baby or child may have cataracts, your GP or the healthcare professional who has examined your child will refer them to:

  • an ophthalmologist: a medical doctor who specialises in eye conditions and their treatment or surgery, or
  • a paediatric ophthalmologist: a medical doctor who specialises in treating children's eyes

Other healthcare professionals may also be involved in their care, such as a paediatrician (a doctor who specialises in children's treatment).

Before the ophthalmologist examines your baby, they will apply drops to their eyes to dilate (widen) the pupils (the black part at the centre of each eye). The drops will not hurt your baby, and the effect will wear off after a few hours.

The ophthalmologist will then examine your baby's eyes using an ophthalmoscope (a medical instrument that has a light on the end and produces a magnified image of your eye). This shines a bright light into your child's eyes and enables the ophthalmologist to look inside them.

The ophthalmologist may diagnose cataracts if:

  • they can see the cataracts in the lens, or
  • the examination shows a poor 'red reflex' in the pupil

The red reflex is like a reflection from the back of the eye that is similar to the red eye effect that is sometimes seen in flash photography. If the examination shows no red reflex, or if it is weaker than usual, there may be cloudiness in the lens.

Other tests

If there is no family history of childhood cataracts, your ophthalmologist may also suggest some other tests in order to identify the cause of the cataracts and confirm the diagnosis. For example, your child may have:

  • blood tests
  • urine tests

 

 

Lens
The transparent structure at the front of your eye, just behind your pupil (the black circle in the centre).

Ophthalmologist
An ophthalmologist is a medical doctor who specialises in eye disease and its treatment or surgery. They mainly work in hospitals and hospital eye departments.

 

Page last reviewed: 13/07/2011

If your baby or child has cataracts, the need for treatment may depend on:

  • whether one or both eyes are affected
  • how mild or severe the cataracts are

Childhood cataracts are very rare, so it can be difficult for healthcare professionals to predict how much a child's vision will be improved by treatment.

Treatment options

Cataracts in babies and children may be treated by:

  • using surgery to remove the cloudy lens and replacing it with an artificial lens
  • wearing glasses
  • wearing contact lenses
  • a combination of these treatments

Surgery

Cataract operations for babies and children will take place in hospital under general anaesthetic (a painkilling medication that makes you unconscious). The operation will be performed by an ophthalmologist (a medical doctor who specialises in eye disease and its treatment or surgery).

If the cataracts are present from birth, the operation will be carried out as soon as possible, usually a few weeks after your baby is born.

Before the operation, the ophthalmologist will apply drops to the eye to dilate (widen) the pupil (the black part at the centre of each eye). A very small incision (cut) is made in the surface (cornea) at the front of the eye, and the cloudy lens is removed.

Without the lens, the eye cannot focus. To correct this, the natural lens may be replaced with a clear plastic lens. This is called an intraocular lens (IOL) or intraocular implant.

In some instances, a contact lens on the eye's surface may be used instead of an IOL. This will be fitted one to two weeks after the operation. 

After the operation

After the operation, your baby or child will have a pad put over the eye that was operated on to protect it. Your child will probably need to stay in hospital overnight or for a couple of days. You may be able to stay with them.

If your baby or child has cataracts in both eyes (bilateral cataracts), the ophthalmologist will probably operate on each eye separately. You and your child will be able to go home after the first operation. The second operation will probably be about a week later.

You will be given eye drops to give to your baby or child at home. These drops help to reduce inflammation (swelling and redness) in the eye. You will need to put them into the eye every two to four hours, and you will be shown how to do this before you leave the hospital.

Further treatment

After a cataract operation, your baby or child will have regular check-ups with an orthoptist. An orthoptist specialises in problems that relate to eye movements and how the eyes work together. They will test your child's vision regularly to pick up and correct any changes in their vision as early as possible.

Most children will need to wear:

  • glasses or contact lenses to improve their vision - these will probably be fitted a few weeks after the operation
  • a patch over their eye - this is called occlusion therapy (see below)

Contact lenses can be used in babies as well as older children. You will be taught how to insert the contact lenses for your child, and how to look after the lenses.

Occlusion therapy

In occlusion therapy, the stronger eye (the eye that sees best) is covered with a patch. This means that the child only uses the weaker eye to see.

This treatment aims to improve vision in the weaker eye. It makes the brain recognise the visual signals from that eye and improves the images it sees.

Your orthoptist will tell you when your child should wear the patch and how long they may need it for. This will depend on the type of cataract that your child had, and how weak their vision is. Wearing a patch can be an unpleasant experience for your child, and they will need lots of encouragement to keep it on.

 

 

Lens
The transparent structure at the front of your eye, just behind your pupil (the black circle in the centre).

Ophthalmologist
An ophthalmologist is a medical doctor who specialises in eye disease and its treatment or surgery. They mainly work in hospitals and hospital eye departments.

Incision
An incision is a cut made in the body with a surgical instrument during an operation.

Cornea
The cornea is the clear outer layer at the front of the eyeball that acts as a window to the eye.

Orthoptist
An orthoptist specialises in problems that relate to eye movements and how the eyes work together.

Page last reviewed: 13/07/2011

If childhood cataracts are not treated, they can cause blindness. In some cases, after cataracts are removed, visual impairment or blindness can remain.

Even if a child's cataracts can be treated successfully, improvement to their vision may be affected by other eye conditions. For example, lazy eye (amblyopia) is an early childhood condition where the child's vision does not develop properly. This will require further treatment, usually by wearing a patch (occlusion therapy) or using eye drops.

Complications from surgery

Complications can arise from an operation to remove childhood cataracts. These can include:

  • glaucoma - increased pressure inside the eye, which affects vision  
  • squint (strabismus) - a condition where one eye turns inwards, outwards, upwards or downwards, while the other eye looks forwards
  • abnormalities affecting the pupil (the black circle at the centre of each eye)
  • vision becoming cloudy again (visual axis opacification or posterior capsule opacification) - this is due to the thickening of the lens capsule (the 'pocket' that the lens sits inside), and may require another operation
  • retinal detachment - when the retina (the layer of nerve cells inside the back of the eye) becomes separated from the inner wall of the eye
  • infection - for example, endophthalmitis (a rare bacterial infection)

 

 

Lens
The transparent structure at the front of your eye, just behind your pupil (the black circle in the centre).

Retina
The retina is the nerve tissue lining the back of the eye, which senses light and colour, and sends it to the brain as electrical impulses.

Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some are good for you.

 

Page last reviewed: 13/07/2011

Childhood cataracts that are inherited (run in the family) cannot be prevented.

Pregnancy

If you are pregnant, you should follow the advice of your midwife or GP to avoid infections during your pregnancy.

If you want to try for a baby, but you do not know whether you are immune to rubella (German measles), you should ask your GP to check your immunity. If necessary, you can be vaccinated against rubella with the MMR vaccine (a vaccine that prevents measles, mumps, and rubella).

After having the MMR vaccine, you should take care to avoid becoming pregnant for one month.

Genetic counselling

If you have previously had a baby with childhood cataracts, and you are planning another pregnancy, you may wish to speak with your GP about whether genetic counselling would be appropriate.

Genetic counselling can help couples who may be risk of passing a genetic condition (a condition inherited from a family member) onto their child.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

Browse Health A-Z