Introduction
Congenital cataracts are a condition where the lens inside the eye is cloudy instead of clear. Babies can be born with cataracts, or they may develop them in their first year of life.
Congenital cataracts cause issues with a child’s vision.
The eye is made up of parts including the:
- iris – the coloured part of the eye
- lens – a clear disc that sits behind the iris
- retina – the inner layer at the back of the eye.
To be able to see clearly, rays of light need to travel through the lens, onto the retina. When the lens is cloudy, light cannot pass through. This stops your baby from being able to see clearly.
Cataracts can happen in one or both eyes. Children at higher risk of congenital cataracts may have:
- a disease or infection like rubella
- a syndrome like Down syndrome
- a family history of cataracts.
In most cases, it's not clear what causes cataracts to develop.
Signs and symptoms
Most cataracts will be very faint at the start. They may not be found until they grow and your child starts to have problems with their vision.
Signs and symptoms of congenital cataracts include:
- leukocoria – when the black pupil of the eye turns thick and white
- constant glare– difficulty seeing clearly due to bright light
- vision that slowly gets worse
- strabismus – also known as crossed eyes or a squint, happening when the eye cannot focus properly.
Diagnosis
See your local doctor if your child starts to have any signs or symptoms.
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 are affecting 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 for treatment and continue to check your child’s eyes regularly.
Cataract surgery
Cataracts must be removed when they affect a child’s vision.
Surgery can be done in hospital to remove the cloudy lens from the eye. Your child will be under a general anaesthetic for the procedure, 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 need:
- to wear an eye patch while they recover
- eye drops regularly throughout the day, as directed by the doctor.
Intra-ocular and contact lenses
Some children will have their lenses replaced with a clear lens made of plastic. This is called an intra-ocular lens (IOL).
IOLs can be inserted during the surgery to remove the lens, or when your child is older.
Some children will not need an IOL and will use 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 teach you and your child how to use and care for contact lenses.
Management
Patching therapy and vision development
A child’s eyes will keep developing until they are around eight years old. This means it's important to check their vision regularly if they have congenital cataracts.
Some children with congenital cataracts might need patching therapy if they develop amblyopia, or lazy eye.
Patching therapy involves covering one eye with a patch to strengthen the weaker eye.
Your child's treatment team will talk to you about whether your child needs patching therapy.
Resources and more information
