Congenital Cataract

What is Congenital Cataract?

Congenital cataract is a clouding of the natural lens of the eye present at birth.

Depending on the density and location of the opacity, congenital cataracts may need to be removed by cataract surgery while the child is still an infant to allow normal development of vision and prevent amblyopia and even blindness.

Some congenital cataracts, however, affect only a small part of the lens of the eye and do not interfere with vision enough to justify surgery.

How common is congenital cataract?

In the United Kingdom, the incidence of detection of cataracts of congenital origin affecting vision has been estimated at 2.49 per 10 000 population by the age of 1 year
Due to some late diagnoses, the incidence increases to 3.46 per 10 000 population by the age of 15. This is equivalent to 200-300 children born with a congenital cataract each year in the UK.

What causes congenital cataracts?

Congenital cataracts can occur in newborn babies for many reasons, such as hereditary diseases, infections, metabolic diseases, diabetes,trauma, inflammation or side effects of medications.

For example, tetracycline antibiotics used to treat infections in pregnant women have been shown to cause cataracts in newborn babies.

Congenital cataracts can also occur when, during pregnancy, the mother develops infections such as measles or rubella (the most common cause), chickenpox, cytomegalovirus, herpes simplex, herpes zoster, polio, influenza, Epstein-Barr virus, syphilis and toxoplasmosis.

Older babies and children can also be diagnosed with cataracts, known as pediatric cataracts, for similar reasons. However, trauma associated with events such as a blow to the eye is the underlying cause in 40 percent of cataract cases in older children.

Also, some pediatric cataracts may actually be congenital cataracts that simply were not detected earlier because the child did not have the first eye examination until grew up.

Types of congenital cataracts

The following are different types of congenital cataracts:

The anterior polar cataract is well defined and is located on the front of the lens. They are often associated with hereditary traits. Many anterior polar cataracts are small and do not require surgery.
The posterior polar cataracts are also well-definedopacities, but they appear on the back of the lens.
Nuclear cataract occurs in the central part of the lens and is a very common form of congenital cataracts.
Cerulean cataracts (blue dot cataracts) are usually localized in both eyes of infants and are distinguished by small, bluish dots in the lens. Typically, this type of cataract does not cause vision problems.

What are the symptoms of congenital cataracts?

Often an infant with mild cataracts appears asymptomatic, delaying the diagnosis for years.

Other times, the white reflection of the pupil of the eye, the lack of reaction to light, strabismus, the inability to observe toys and faces, or the apparent delay in development become a cause of concern. Mild cataracts can cause photophobia only in bright lights. Dense cataracts can also be discovered if they lead to the development of sensory nystagmus.

When does my child need cataract surgery?

Opinions vary on when surgery should be performed if a child has congenital cataracts.

Some experts say that the optimal time to intervene and remove a visually significant congenital cataract is between 6 weeks and 3 months.

If your baby has a congenital cataract, discuss any concerns you have about the timing of cataract surgery with your pediatric ophthalmologist.

Once the cataract is removed, it is absolutely essential to correct your child’s vision with a surgically implanted intraocular lens (IOL), contact lens or glasses. Without vision correction after cataract surgery, the eye will have poor eyesight and the normal development of infant vision will be affected.

Opinions also vary on whether an artificial lens should be surgically placed on a baby’s eye after cataract surgery due to concerns that it may affect the normal development of the eye and complications of using it. An intraocular lens may also need to be removed and replaced as your child grows up due to possible changes in vision.

In some cases, contact lenses placed on the surface of the eye (cornea) may be used to help restore vision after removing the natural lens during cataract surgery. Also, glasses may be prescribed to help vision instead of amounted artificial lens or contact lens.

If our optician or pediatric ophthalmologist recommends contact lenses to you after a congenital cataract surgery, contact lenses of usually prolonged use will be prescribed to simplify the care and handling of contact lenses.

You will receive training from ouroptician or our pediatric ophthalmologist on how to put on and remove your child’s lenses. Often, this can be done while your infant or very young child is sleeping.

Congenital cataracts and other vision problems

Without timely intervention, congenital cataracts cause amblyopia (lazy eye). This condition can then lead to other problems in the eyes, such as nystagmus, strabismus and inability to look at objects.

Such problems can deeply affect the learning ability, personality and even appearance, ultimately affecting the entire life of a child. For these and many other reasons, make sure your child does a routine eye examination at the age of 6 months, again at the age of three years and once again before starting school.