Cataracts in children infantile cataracts signs and treatment

Pediatric Cataracts, also known as childhood cataracts, occur when the lens of the eye becomes cloudy or opaque, making it difficult for a child to see clearly. This condition can be present at birth (congenital cataracts) or may develop during the first few years of life. In most cases, early diagnosis is essential to prevent long-term vision problems and to ensure healthy visual development.In this Dalili Medical article, we will explore the causes of pediatric cataracts, their types, symptoms, diagnostic methods, and all available treatment options including medications and surgery. We will also provide essential tips for parents on prevention and follow-up care. These insights will help you understand how to protect your child’s vision and maintain healthy eyes for the future.

What Is Pediatric Cataract?

Pediatric cataract, also known as childhood cataract, is a condition where the eye’s natural lens becomes cloudy or opaque. The lens is normally clear and located directly behind the iris, allowing light to focus on the retina for clear images. When the lens becomes cloudy, light scatters, and images appear blurred or distorted on the retina.

How Does Cataract Affect a Child’s Vision?

Some newborns with mild cataracts may still achieve good vision if treated early.
Severe cases, however, can cause significant visual impairment and may even lead to blindness if left untreated.

Is Pediatric Cataract Surgery Painful?

Children may experience mild pain or discomfort during surgery.
After an artificial lens is implanted, the child usually does not feel its presence.
If contact lenses are prescribed after surgery, the child may initially notice them but typically adapts over time.

Will the Child Need More Than One Treatment?

After surgery, some children may develop posterior capsule opacification (PCO), also called “after-cataract.”
Most cases can be corrected with a simple laser procedure, while more complex cases may require additional surgery.

Long-Term Outlook After Pediatric Cataract Surgery

Infants born with congenital cataracts have the best chance of recovery if treated within the first two months of life.
Delayed treatment significantly reduces the chances of full visual recovery.
Children who develop cataracts later in infancy usually have a good prognosis since some visual development has already occurred.
After surgery, many children need to wear an eye patch for a period of time to support normal visual development.

What Happens During Pediatric Cataract Surgery?

Examination Under Anesthesia (EUA):

The ophthalmology team evaluates the child’s eyes under anesthesia.
Eye measurements are taken to determine the appropriate artificial lens.

Lens Removal and Artificial Lens Implantation:

A small incision is made in the cornea.
The cloudy lens is carefully removed.
A clear intraocular lens (IOL) is implanted.
In some cases, a small posterior opening is made to prevent scar formation.
The incision is closed with dissolvable stitches that do not require removal.

How Is Pediatric Cataract Surgery Different From Adults?

Duration: Longer in children, usually 2–3 hours.
Anesthesia: Requires general anesthesia.
Hospital Stay: Often done as an outpatient procedure, allowing the child to go home the same day.

How Common Are Pediatric Cataracts?

Less common in children compared to adults.
In Australia, about 1 in every 5,000 children is born with congenital cataracts.
Globally, the prevalence is about 1.04 per 10,000 children.

Age Range for Pediatric Cataracts

Can occur at any age, from birth through adolescence.
Congenital cataracts: Present at birth.
Acquired cataracts: Develop later due to trauma, metabolic diseases, radiation, or certain medications.

When Does a Child Need Cataract Surgery?

Surgery is usually recommended as soon as possible after diagnosis.
Early surgery improves visual outcomes and reduces the risk of permanent visual impairment.

Risks of Pediatric Cataract Surgery

Although generally safe, possible risks include:

Infection (rare, reduced with antibiotics).
Vision loss (extremely rare if performed correctly).
Retinal detachment (rare, especially in children with pre-existing eye problems).
Glaucoma (increased eye pressure, may develop after surgery).

⚠️ Long-term follow-up is essential to monitor vision and manage any complications.

Age Considerations for Surgery

There is no fixed minimum age, but early intervention is crucial.
Implanting artificial lenses in very young infants may increase the risk of glaucoma.
Surgery before 4 weeks of age carries higher anesthesia risks, while delaying beyond 6 weeks increases the risk of amblyopia (lazy eye).
For unilateral congenital cataracts, surgery is typically recommended between 4–6 weeks of age.

Causes of Pediatric Cataracts

Genetic/Inherited: Family history or gene mutations.
Eye injuries/trauma.
Maternal infections during pregnancy: e.g., rubella.
Systemic diseases or metabolic disorders: e.g., diabetes.
Medications or radiation exposure.
Unknown causes in some cases.

Symptoms of Pediatric Cataracts

Blurred or cloudy vision.
White or gray pupil instead of normal black.
Sensitivity to light (photophobia).
Difficulty focusing or following objects.
Double vision.
Eye misalignment (strabismus).
Delayed visual development.

Stages of Pediatric Cataracts

Mild/early: Slight cloudiness, minimal vision problems.
Progressive: Increasing cloudiness, noticeable vision impairment.
Moderate: Clear reduction in vision, often with strabismus.
Severe/complete: Nearly or fully opaque lens, urgent surgery required.

Types of Pediatric Cataracts

Congenital cataract: Present at birth.
Acquired cataract: Develops after birth.
Partial cataract: Affects part of the lens.
Total cataract: Affects the entire lens.
Nuclear cataract: Forms in the center of the lens.
Cortical cataract: Forms at the edges of the lens.

Risks of Untreated Pediatric Cataracts

Permanent vision loss.
Strabismus (eye misalignment).
Delayed visual and learning development.
Difficulties with fine detail and color perception.
Higher risk of complications during late surgery.

Diagnosis of Pediatric Cataracts

Medical history and eye exam (checking for family history, trauma, or maternal infections).
Vision tests (age-appropriate).
Ophthalmoscopy to examine inside the eye.
Ultrasound or slit-lamp imaging for detailed assessment.
Genetic or blood tests in congenital cases.

⚠️ Early diagnosis is key to preventing long-term visual problems.

Can Pediatric Cataracts Be Treated With Medication?

In most cases, surgery is necessary.
Eye drops (anti-inflammatory or steroid drops) may be used to control inflammation, but they do not cure cataracts.
Medication is only supportive, not a substitute for surgery.

Non-Surgical Treatment of Pediatric Cataracts

Artificial Tears (Lubricating Eye Drops)

Reduce dryness and irritation caused by medications or blurred vision.
Very safe for children and provide extra comfort.

Medications for Underlying Conditions

If the cataract is caused by conditions such as diabetes or eye infections, the doctor may prescribe medications to control the root cause.

⚠️ Note: Medications alone are usually not enough to treat cataracts in children. Surgery remains the most effective option in most cases.

Surgical Treatment of Pediatric Cataracts

Surgery is the most effective way to restore vision and prevent visual development problems in children. Different types include:

1. Traditional Lens Removal (Lensectomy)

The cloudy lens is completely removed through a small incision.
The child may need an intraocular lens (IOL) or special high-powered glasses afterward.
Commonly used in younger children or when the cataract is very dense.

2. Intraocular Lens Implantation (IOL)

After removing the cloudy lens, a clear artificial lens is implanted.
Suitable for older children or when there is enough space inside the eye.
Sometimes the lens may need to be adjusted as the child grows.

3. Phacoemulsification (Ultrasound Cataract Surgery)

A modern technique that breaks up the cloudy lens using ultrasound before removing it through a very small incision.
Minimally invasive with a shorter recovery period.
More suitable for older children or those with partial cataracts.

4. Microsurgical Cataract Extraction

Performed using a surgical microscope for precise removal of the cataract.
Often used for complex cases or partial cataracts.

5. Infant Cataract Surgery

More delicate due to the very small size of the eye.
Usually involves lens removal, sometimes followed by temporary glasses or later IOL implantation.
Requires close follow-up to prevent complications such as strabismus or inflammation.

Possible Complications After Surgery

Eye infection or inflammation.
Increased eye pressure (glaucoma).
Posterior capsule opacification (secondary cataract) that may require a second surgery or laser treatment.
Strabismus (eye misalignment) or poor visual focus if treatment is delayed.

Tips for Parents Before and After Pediatric Cataract Surgery

Follow the doctor’s instructions: Adhere carefully to ensure successful surgery and recovery.
Use prescribed eye drops and antibiotics: Administer exactly as directed in terms of dosage and timing.
Regular follow-up visits: Monitor healing and visual development through scheduled checkups.
Watch for warning signs: Report any redness, swelling, or unusual discharge to the doctor immediately.

Vision Therapy and Exercises After Surgery

Visual exercises are important after cataract removal or lens implantation to improve eyesight and support visual development:

1. Near and Far Focus Exercise

Ask the child to focus on a near object (toy or pen), then shift to a distant object.
Repeat 10 times daily.

2. Eye Tracking Exercise

Move a toy or pen slowly left, right, up, and down.
Let the child follow it using only their eyes.
Repeat 5–10 times, twice daily.

3. Strabismus Exercises (if present)

Use a toy or pen at medium distance.
Ask the child to follow it while covering one eye alternately.
Repeat several times daily, based on the doctor’s guidance.

4. Blinking Exercise

Gently close eyes for 3–5 seconds, then open.
Repeat 10 times, 2–3 times per day.
Helps stimulate natural tears and keep the eyes moist.

5. Gentle Eye Massage

With clean fingers, massage around the eyes in small circular motions for 1–2 minutes, once or twice daily.
Improves blood circulation and reduces eye strain.