Congenital cataracts are present in newborns, clouding the lens of one or both eyes and causing early problems with vision. (Learn More)

Some viruses and genetic conditions increase the risk of your infant having cataracts, which can lead to trouble focusing on their surroundings, ignoring some stimuli, or rapid eye movements to focus on objects in front of them. (Learn More) Staying healthy during pregnancy is the only way to reduce congenital cataract risk, but you cannot fully prevent this problem. (Learn More)

Fortunately, treatment is safe and effective. Your pediatric ophthalmologist will determine if your child’s congenital cataracts need surgery. (Learn More)

What Are Congenital Cataracts?

eye with cataracts

Cataracts are one of the most common eye disorders, and congenital cataracts are one of the leading, treatable causes of blindness in children. An estimated 200,000 children are blind from unoperated cataracts. Others have partial cataracts, which get worse over time, requiring ongoing medical treatment.

Cataracts that are congenital are present at birth, clouding the normally clear lens of the infant’s eye.

It may be difficult to know for sure if your child has cataracts. Newborns and young babies cannot see well. They are typically a little hyperopic, or farsighted. They do not have good color sense and have trouble focusing on objects. However, a healthy infant can see movement and will follow people or objects around a room or outside.

Hyperopia will increase some in the first weeks or months, and then decrease as vision evens out. If your child does not follow motions, appears to ignore part of the world around them, or develops rapid eye movements to process images, they may have a cataract.

Symptoms of Congenital Cataracts

If your baby is born with congenital cataracts, they may look different than adulthood cataracts, which begin in late middle age and progress over decades.

Symptoms of congenital cataracts can be hard to spot, although your obstetrics team should be able to identify some signs. These include:

  • Lack of visual awareness of the world or lack of response to visual stimuli.
  • Gray, white, or cloudiness in the pupil, which is normally black.
  • Photos of your child’s face lack the “red eye glow” or that glow is missing in one eye.
  • Nystagmus, or unusual eye movements back and forth.

The only way to know if your child has congenital cataracts is to have a pediatric ophthalmologist evaluate your baby’s eyes. If the underlying cause is a genetic disorder, working with an ophthalmologist who specializes in these conditions can improve outcomes. Understanding if a genetic disorder caused congenital cataracts may require blood tests.

What Causes Congenital Cataracts?

Typically, the underlying cause of congenital cataracts is unknown. The baby is born with them, and parents work with their pediatric ophthalmologist to treat the condition as much as possible.

While there is no known direct cause of congenital cataracts, some conditions and infections increase your baby’s risk of developing cataracts. These conditions include:

  • Chickenpox.
  • Congenital rubella.
  • Lowe syndrome
  • Marinesco-Sjögren syndrome.
  • Conradi-Hünermann syndrome.
  • Cytomegalovirus.
  • Down syndrome/trisomy 21.
  • Trisomy 13.
  • Familial congenital cataracts.
  • Ectodermal dysplasia syndrome.
  • Familial congenital cataracts.
  • Galactosemia.
  • Hallermann-Streiff syndrome.
  • Herpes.
  • Chondrodysplasia syndrome.
  • HIV.
  • Pierre-Robin syndrome.
  • Toxoplasmosis.

About 50 percent of childhood cataracts are associated with genetic mutations coding for proteins in the lens of the eye. Metabolic disorders are also associated with congenital cataracts. Trauma during the pregnancy or birth can damage proteins in the lens and cause cataracts as well.

Can You Prevent Congenital Cataracts?

Since congenital cataracts are present at birth, there is nothing you can do to prevent them. Even if your child has a condition that puts them at higher risk of congenital cataracts, you cannot predict for sure if they will develop them or not. Work with your OBGYN to keep yourself as healthy as possible during pregnancy, and this can reduce some risks like viruses.

If your child does get congenital cataracts, removing them involves a safe, effective procedure. The diagnostic process is not invasive. Working with a pediatric ophthalmologist ensures your child will have the best possible vision.

After cataract surgery, there is some risk that your child could develop cataracts again, later in life. This is typically associated with genetic disorders, which will require treatment from a pediatrician and other specialists throughout life. Your pediatric ophthalmologist will generally recommend blood tests to determine if a genetic disorder is the cause of the issue.

It is important to get treatment for your child as soon as possible. Not only can your child struggle with “lazy eye” and blurry vision from untreated cataracts, they may also:

  • Suffer a retinal detachment.
  • Have one eye not line up with the other (strabismus).
  • Develop high fluid pressure in the eye, which damages other parts of the organ (glaucoma).

Treating Congenital Cataracts

Mild cataracts may cause poor quality vision in babies, but your pediatric ophthalmologist may determine that they are not severe enough for surgery. Moderate or severe cataracts that affect vision, especially in only one eye, will require cataract removal surgery.

For adults, cataract surgery removes the natural lens in the eye, which is located behind the cornea and pupil. The lens should refract light back onto the retina, but cataracts can cause blind spots, blurry vision, or darkened patches.

Adults typically receive an intraocular lens (IOL), which is an artificial lens working similarly to the natural lens, but often with less depth perception. IOLs for infants or babies are controversial, but the infant will need to wear a contact lens so they can see if they do not receive an IOL.

Your pediatric ophthalmologist will also watch your child’s eye for amblyopia, or weakness in one eye leading to lower levels of sight. Your child may wear an eye patch for a few months or years, to ensure the brain connects to the nondominant eye and can process images. The treatment timeline for this issue varies according to the severity of the condition.

There are some risks with cataract surgery in babies, as with any surgical procedure for any age group. Side effects are rare, but may include the following issues:

  • Inflammation
  • Infection
  • Bleeding

Your pediatric ophthalmologist will continue to assess your child’s vision and eye health after the surgery to ensure issues do not become serious. If the above conditions occur, they can then be promptly treated.

Between birth and 2 years old, children should see an optometrist or ophthalmologist every six months to one year for eye exams. Some pediatricians conduct eye exams in an office with newer technologies.

If your child has congenital cataracts, you may see an eye doctor more frequently. This frequency of regular appointments can continue throughout your child’s life. It helps your pediatric ophthalmologist to manage your child’s vision, ensuring the best sight and eye health possible.

 

References

Congenital Cataract. (August 2017). MedlinePlus.

Pediatric Cataracts: Overview. (November 2015). American Academy of Ophthalmology (AAO).

Pediatric Cataract. (December 2017). Indian Journal of Ophthalmology.

Congenital Cataracts. (October 2019). KidsHealth.

Congenital Cataract. (October 2018). Merck Manual: Consumer Version.

Recommended Eye Examination Frequency for Pediatric Patients and Adults. American Optometric Association (AOA).

Your Child’s Eye Care. Prevent Blindness.