Introduction
Congenital cataracts are when your baby is born with the lens inside their eye being cloudy instead of clear. This condition can be seen when your baby is born, or it can develop in the first year of life.
The eye's lens is a clear disc found behind the iris, the coloured part of the eye.
The lens focuses light rays onto the retina, the inner layer at the back of the eye. For your child to be able to see, the light needs to pass through the lens to the retina. Cataracts stop the light from being able to pass through, which stops your baby from seeing properly.
Cataracts can happen in one or both eyes.
Cataracts can be linked to diseases and infections like rubella and some syndromes like Down syndrome. Some children may have a family history of cataracts. In most cases, it's not clear what has caused the cataracts to happen.
Signs and symptoms
Most cataracts are faint enough that they are not picked until they slowly get denser and cause your child to lose their vision. When the eye lens becomes cloudy, it will get thicker, and the pupil will look white instead of black. This is known as Leukocoria.
Other symptoms of congenital cataracts include:
- constant glare in the eyes, like the effect of car headlights through a dirty windscreen at night
- vision that slowly gets worse
- developing strabismus – also known as crossed eyes or a squint, which happens when the eye cannot focus properly.
Diagnosis
Your child's doctor will refer you to a specialist eye doctor called an ophthalmologist who can diagnose congenital cataracts.
The ophthalmologist will use special eye drops to make your child's pupils very wide before using a tool called an ophthalmoscope to check the lens and retina.
Treatment
How congenital cataracts are treated will depend on how dense they are and whether they affect your child's ability to see well.
Watch and wait
If the cataracts are not affecting your child’s vision, the doctor may choose to wait and keep checking your child’s eyes. If their vision eventually starts to become affected, the lens must be removed.
Cataract surgery
Treatment of cataracts affecting vision is done through surgery to remove the cloudy lens from the eye. This surgery is done in the hospital while your child is under a general anaesthetic, which means they will be asleep and not feel any pain.
The surgeon will make a small cut in the eye and remove the cloudy lens. This will take about an hour, and your child may be able to go home the same day, depending on what time the surgery is done and how well they recover.
After the surgery, your child will wear an eye patch. You will then need to give your child eye drops regularly throughout the day for as long as the doctor tells you.
Intra-ocular and contact lenses
Some children will have their lenses replaced with an intra-ocular lens (IOL), a clear lens made of plastic. The replacement lens can be inserted during the surgery or when your child is older in a second operation.
Some children will not have an IOL inserted and will manage their vision using contact lenses. Contact lenses are thin, curved lenses that are placed on the surface of the eye to correct vision problems.
A vision specialist, known as an orthoptist, will have an appointment with you and your child to teach you about inserting, removing, cleaning, and caring for the contact lens.
Management
Vision development and patching therapy
Your child’s vision develops quickly in the first few years of life and continues to develop up until the age of eight. Children with congenital cataracts must have their vision checked regularly as they grow.
Some children will also need patching therapy for amblyopia, also known as lazy eye, caused by the cataract.
Patching therapy is a treatment where one eye is covered with a patch to encourage the use of the weaker eye.
Your child’s ophthalmologist and orthoptist will talk to you about whether your child can benefit from patching therapy.
Resources and more information
