Children could be having cataracts right from birth. We refer to them as congenital cataracts. Fortunately, they are rare occurrences. Like many others, you may not even be aware that your child is having a cataract because children generally never complain of poor vision. It might be even more difficult when the child of suffering from poor vision due to cataracts in both eyes. Therefore, only the ophthalmologist, who puts the child through a complete eye examination, will be able to help you with the right assessment.

Symptoms of Congenital Cataracts

These cataracts are different in appearance, compared to the other types. There may be a cataract in only one eye, or in both eyes.

  • The pupils of the eyes are generally black in colour. However, cataracts can make them look cloudy.
  • The cloudiness may be white or grey.
  • Even when photographers give prominence to the patient’s eyes, the pupils fail to display the expected red reflex.
  • Sometimes, the red reflex is different in each eye.
  • The infant/child exhibits no awareness of the environment around him/her.
  • Then again, eye movements may appear more rapid than normal. This condition is nystagmus.
  • Another issue is strabismus (squint), wherein the eyes are not in alignment with one another.
  • A third issue is the eyes’ inability to gaze upon anything. They keep moving here and there.
  • Congenital cataracts may lead to the development of lazy eye (amblyopia) too. 
  • The child finds images rather blurry, due to the irregular curvature of the corneas. This is condition is called astigmatism and is frequently associated with congenital cataracts.

Early surgical intervention is important because once amblyopia develops the affected eye may never regain normal vision.

Congenital cataract

Figure 1. Congenital cataract

Causes of Congenital Cataracts

A newborn is at risk for several reasons.

  • The pregnant woman or the baby in the womb could be experiencing a reaction to drugs or antibiotics. For instance, tetracycline  used for treating infections during pregnancy may cause congenital cataracts. 
  • Similarly, the would-be-mother might fall prey to influenza, measles, chickenpox and a host of other severe infections. 
  • Other causes include inflammation, metabolic issues, trauma, diabetes and inherited tendencies.

How do congenital cataracts form?

  • The lenses of the eyes are partly solid (protein fibres) and partly liquid (water).
  • When protein fibres clump together, resembling a milky-white, opaque mass, they result in  congenital cataracts.
  • The commonest type is nuclear congenital cataract, which affects the central region of the lens.
  • The posterior polar type affects the region at the back of the lens.
  • The anterior polar type affects the front portion of the lens. They are small and inherited. 
  • Bluish dots are again a sign of inherited tendencies. They are small, cerulean congenital cataracts.

Treatment of Congenital Cataracts

Treatment of congenital cataract depends on the type of cataract and its effect on vision. For example, a blue dot cataract or a lamellar cataract may not affect the child’s vision and the refractive power can just be corrected with spectacles. However, there are other more severe forms of cataracts which may affect the child’s vision and Cataract surgery is the only option in these cases.

  • Cataract surgery is performed under general anaesthesia and close follow up is required following surgery. The child will require near vision glasses following surgery due to loss of accommodation.
  • The biggest risk after surgery is  glaucoma (optic nerve damage due to raised intraocular pressure. Hence these children require close follow up.
  • Patients with congenital cataracts require good eye care for the rest of their lives.