Cataracts in childrens eyes danger signs and early treatment methods

Have you ever noticed a white spot in your child’s eye or that they struggle to see things clearly? This could be a sign of pediatric cataracts, a condition that affects the eye’s lens and reduces vision clarity. Cataracts in children can be congenital (present at birth) or develop later due to infection, injury, or underlying health problems. If not detected and treated early, pediatric cataracts may lead to delayed visual development or even permanent vision problems.In this Dalili Medical article, we’ll explain the causes of cataracts in children, their symptoms, possible risks, and the best prevention and treatment options—all in a simple and clear way to help every parent protect their child’s eyesight.

What Is Pediatric Cataract?

A pediatric cataract is a clouding of the normally clear lens of the eye in children. This cloudiness prevents light from passing properly to the retina, leading to blurred or reduced vision and affecting the child’s ability to see clearly.

When Should Pediatric Cataract Surgery Be Performed?

Early detection is crucial to protect a child’s eyesight and prevent permanent damage.

Surgery is usually recommended within the first few weeks of life and no later than the first two months.
Timing depends on:
- Severity of lens opacity.
- Number of affected lenses:
  - If one eye is affected → surgery can be done at 4 weeks of age.
  - If both eyes are affected → surgery is usually performed after 6 weeks of birth.

Does Cataract Surgery Restore Vision for Life?

After surgery, most children regain clear vision and can live a normal life, including school and daily activities.

Some children may still need glasses or contact lenses to correct minor vision issues.
Regular follow-ups are essential to track vision development.

Can Both Eyes Be Operated On?

Yes, but usually one eye at a time to reduce risks.

Surgeries are often scheduled about a week apart.

When Will the Child’s Vision Stabilize After Surgery?

Vision improves gradually: about 80% improvement in the first 4 days.
Clarity continues to improve for up to 6 months with proper care and follow-up.

Do Intraocular Lenses (IOLs) Affect Children’s Vision?

Quality of the IOL matters:
- High-quality lenses provide clearer vision at different distances.
- They reduce glare and lower the risk of complications.
Monofocal vs. Multifocal Lenses:
- Monofocal IOLs: Clear vision at one distance (usually far). Glasses may be needed for near vision.
- Multifocal IOLs: Correct both near and far vision, but rarely used in children because their eyes don’t adapt well.
Child-Specific Lenses:
- Designed for small, growing eyes.
- Provide better stability inside the eye.
- Lower risk of displacement or movement.
Impact on Vision Development:
- Children may still need glasses or additional correction.
- Regular follow-up ensures healthy visual development and prevents complications such as lazy eye (amblyopia) or squinting (strabismus).

When Should a Child Undergo Cataract Surgery?

Newborns (0–2 months): Surgery should be done as early as possible to protect brain and vision development.
Around 1 year: Surgery is important but not as urgent as in newborns.
Over 3 years: Surgery can be planned with more flexibility, and alternatives may be considered.

Does Crying Affect Cataract Surgery?

Before surgery: Normal crying is not dangerous but may complicate preparation for anesthesia.
During surgery: Children are under general anesthesia, so crying has no effect.
After surgery: Excessive crying may cause temporary swelling or tear production.
- Parents can help by calming the child, using protective eye shields, and applying prescribed eye drops.

Is Pediatric Cataract Surgery Dangerous?

The procedure is very safe with a success rate of about 99%.
Success depends on:
- The surgeon’s expertise.
- Using the right type of IOL for the child.

Success Rates by Age:

Before 1 year: ~72.2% success.
After 1 year: ~38.9% success.
???? This shows why early surgery is highly recommended.

Pediatric Cataract Types

Congenital Cataracts – Present at birth or in the first year.
- Causes: genetic, hereditary, or infections during pregnancy (e.g., rubella).
- May affect one or both eyes.
Acquired Cataracts – Develop after birth.
- Causes: eye trauma, infections, diabetes, metabolic disorders, or drug side effects.
Cataracts Linked to Pregnancy Infections – Caused by maternal infections like rubella or syphilis.
Metabolic or Rare Disorders – Inherited metabolic conditions (e.g., galactosemia) can trigger cataracts.
Partial or Incomplete Cataracts – Cloudiness affects only part of the lens, allowing partial light passage. Often diagnosed only through an eye exam.

Causes of Pediatric Cataracts

Congenital: hereditary, genetic mutations, or structural defects.
Acquired: trauma, severe infections, diabetes, or drug exposure.
Pregnancy-Related Infections: rubella, syphilis, or other maternal infections.
Metabolic Disorders: rare inherited conditions affecting lens clarity.

Stages of Cataracts in Children

Mild Lens Opacity: Slight cloudiness, often unnoticed.
Moderate Opacity: Child shows difficulty focusing, light sensitivity.
Severe/Total Opacity: Lens fully clouded, leading to major vision loss.
Complications: Untreated cataracts may cause permanent blindness, squinting, or developmental delays.

Symptoms of Pediatric Cataracts

White or gray spot in the pupil (most common sign).
Poor tracking of objects/toys.
Squinting (strabismus).
Sensitivity to light (photophobia).
Delayed visual responses in infants.
Using one eye more than the other.

???? Any white spot in a child’s eye should be checked immediately by a pediatric ophthalmologist.

Diagnosis of Pediatric Cataracts

Eye Examination: Checking lens transparency, eye alignment, and pupil response.
Vision Tests: For older children (charts, shapes); for infants, light response and eye tracking.
Imaging Tests: Ultrasound or retinal imaging if the lens is too opaque.

4. Medical History

When did the white spot first appear?
Family history of cataracts or other eye problems.
Mother’s health during pregnancy (infections or medications).
Any past eye injuries or infections in the child.

5. Differential Diagnosis

It’s important to rule out other causes of white spots in the eye, such as:

Corneal infections or other eye inflammations.
Intraocular hemorrhage (bleeding inside the eye).
Congenital anomalies of the pupil or cornea.

Steps of Pediatric Cataract Surgery

1. Preoperative Preparation

Comprehensive eye exam: full evaluation of the eye, intraocular pressure measurement, retina and cornea assessment.
Medical tests: blood work, anesthesia evaluation, and other tests to ensure the child’s safety.
General anesthesia: most children need it since they cannot cooperate like adults.

2. Eye Cleaning and Sterilization

Cleaning the eye and surrounding area thoroughly.
Applying sterile covers and protective drapes over the face and head.

3. Lens Opening and Cataract Removal

A very small incision is made in the front of the eye (cornea or sclera).
The cloudy lens is removed using a technique suitable for the child’s age and lens size.
In some cases, phacoemulsification (ultrasound fragmentation of the lens) may be used if the cataract is advanced.

4. Intraocular Lens (IOL) Implantation

Usually performed in older children, depending on eye size.
For very young infants, IOL implantation may be delayed, and temporary correction is provided using contact lenses or special glasses.

5. Closing the Incision

The incision may be closed with fine sutures or self-sealing techniques, depending on its size.
Antibiotic and anti-inflammatory eye drops are applied immediately after surgery.

6. Postoperative Recovery

Monitoring the child after anesthesia in the recovery room.
Prescribed eye drops to prevent infection and inflammation.
A protective eye patch is placed for a few days.
Scheduled follow-up visits to check intraocular pressure, visual progress, and IOL stability.

Possible Complications of Pediatric Cataracts

Vision Problems
- Partial or complete vision loss if untreated.
- Delayed visual development, especially in the first year of life.
Strabismus (Crossed Eyes)
- Caused by imbalance in vision between both eyes.
Learning and Interaction Difficulties
- Struggles at school, difficulty following objects, or distinguishing colors.
Post-surgical Infection or Inflammation
- Usually preventable with prescribed antibiotic drops.
Surgical Complications
- Dislocation of the implanted lens.
- Raised intraocular pressure after surgery.
- Blurred or distorted vision requiring glasses or contact lenses.
Long-term Complications
- Permanent vision loss if untreated.
- Secondary cataracts may appear and sometimes require laser treatment.

Treatment Options for Pediatric Cataracts

1. Surgical Treatment (Main Option)

General anesthesia.
Small incision to remove the cloudy lens (manual or phacoemulsification).
Implantation of an intraocular lens (if suitable) or temporary correction with glasses/contact lenses.
Post-op care includes antibiotic and anti-inflammatory drops with regular follow-up.

2. Visual Correction After Lens Removal

Glasses for children.
Contact lenses for infants and toddlers until IOL implantation is possible.
Regular adjustments as the child grows.

3. Supportive Medical Treatment

Antibiotic eye drops (e.g., Tobramycin, Erythromycin, Moxifloxacin).
Anti-inflammatory/steroid drops to reduce swelling and irritation.
Lubricating drops for dryness.
Pain relief (paracetamol or ibuprofen for children).
Pressure-lowering medications if needed.

4. Observation or Non-surgical Monitoring

Suitable for mild or partial cataracts that don’t significantly impair vision.
Regular checkups with slit-lamp exams and visual response tests.
Vision therapy exercises to strengthen the affected eye.
Surgery becomes necessary if cataract size increases or vision worsens.

After Pediatric Cataract Surgery – Parental Care

Eye Protection
- Eye patch or shield, especially during sleep.
- Strict use of prescribed drops.
- Gentle cleaning of discharge using sterile cotton or gauze.
Vision Monitoring
- Observing how the child tracks toys or objects.
- Watching for strabismus or focus issues.
- Regular follow-ups with the ophthalmologist.
Environmental Protection
- Avoid dust, smoke, and strong chemicals.
- Sunglasses for older children outdoors.
Medical Follow-ups
- Routine checks for intraocular pressure, IOL stability, and eye clarity.
- Report warning signs like redness, swelling, pus, persistent pain, or sudden vision changes.
Postoperative Vision Correction
- Glasses or contact lenses may still be necessary.
- Adjustments according to eye growth.
Long-term Prevention
- Hand hygiene before touching the eye.
- Clean pillows, towels, and baby items to avoid infections.
- Visual training and exercises if prescribed.

Prevention of Pediatric Cataracts

During Pregnancy
- Regular prenatal care.
- Vaccination against rubella and prevention of infections.
- Avoiding harmful medications without medical advice.
- Balanced diet rich in essential vitamins.
Newborn Screening
- Eye exam immediately after birth.
- Monitoring for white spots or unusual eye reflections.
Eye Protection
- Prevent head or eye injuries during play.
- Safety glasses for sports in older children.
Infection Control
- Proper handwashing.
- Cleaning discharge gently.
- No towel or pillow sharing.
Nutrition for Eye Health
- Foods rich in Vitamins A, C, and E (carrots, sweet potatoes, citrus, spinach, nuts).
- Omega-3 fatty acids from fish or supplements.
Regular Eye Check-ups
- Especially important with family history of cataracts.
- Early diagnosis prevents long-term vision impairment.