Cataracts waiting living in children

Overview

A cataract is a clouding of the lens inside the eye. In children, this means the lens becomes cloudy, making vision blurry or blocked. It can be present at birth (congenital) or develop later due to injury, illness, or other conditions.

Cataracts in children are much less common than in adults. In the UK, about 2 to 3 in every 10,000 babies are born with cataracts.

Cataracts can affect children from birth through adolescence. They can occur in one or both eyes and may be linked to genetic conditions, infections during pregnancy, or eye injuries.

Symptoms

Common symptoms

• A white or yellowish glow in the pupil (the black center of the eye)
• Eyes that do not appear to look in the same direction (strabismus or squint)
• Poor vision that does not improve with glasses
• Nystagmus – uncontrolled back-and-forth or up-and-down eye movements
• Difficulty following objects or recognizing faces at a normal distance

Symptoms in children

• Parents might notice a white or cloudy spot in the child’s eye, especially in photos (the red reflex may be missing).
• The child may seem clumsy or have trouble reaching for things.
• For infants: delays in developmental milestones like reaching, grasping, or making eye contact.
• School-aged children may complain of blurry vision or do poorly on vision tests.

Symptoms in older adults

• Gradual blurring or dimming of vision
• Colors look faded or yellowed
• Glare from lights, especially at night
• Difficulty reading or seeing in dim light

Causes

Main causes

• Congenital: genetic factors (inherited conditions like Down syndrome), infections during pregnancy (like rubella), or metabolic disorders.
• Acquired: eye injuries, inflammation (uveitis), or long-term use of steroid medications.
• Sometimes the cause is not identified.

Risk factors

• Family history of childhood cataracts
• Maternal infections during pregnancy (e.g., rubella, cytomegalovirus)
• Premature birth or low birth weight
• Eye trauma or previous eye surgery
• Certain medical conditions (e.g., galactosemia, diabetes)

When to see a doctor

See a doctor urgently if:

• If you notice a white or cloudy pupil, or your child cannot see as well as usual.
• After an eye injury, even if vision seems okay.
• If your child complains of new, persistent eye pain or headaches.

Book a routine appointment if:

• Standard newborn eye checks and red reflex tests are done in hospital.
• All children should have regular vision screening at their health check-ups (UK: at 6–8 weeks, 1 year, and before school).
• If you have any concerns about your child’s vision, see a doctor or optometrist.

Diagnosis

A doctor or eye specialist (ophthalmologist) will examine your child’s eyes. They may use drops to enlarge the pupils (dilate) for a better view.

Tests that may be done

• Red reflex test: A light is shone into the eye to check for a normal red reflection from the back of the eye.
• Slit-lamp examination: A microscope with a bright light to look at the lens and other eye structures.
• Vision tests appropriate for the child’s age (e.g., ability to fix and follow a toy for infants, picture charts for toddlers, letter charts for older children).

What to expect at your appointment

The examination is painless. Dilating eye drops may sting briefly and cause blurred vision for a few hours. The doctor will discuss findings and next steps with you. You may be referred to a paediatric ophthalmologist (a doctor who specialises in children’s eye care).

Treatment

Surgery is the main treatment for cataracts that affect vision. The goal is to remove the cloudy lens so clear images can reach the back of the eye. After surgery, your child will need help to focus, usually with glasses, contact lenses, or an artificial lens implant (inserted during surgery).

Self-care at home

• Protect your child’s eyes from injury with safety goggles during sports or play.
• Follow all post-surgery care instructions, such as using prescribed eye drops and avoiding rubbing the eyes.
• Attend all follow-up appointments to monitor vision and eye health.

Medical treatments

Treatment is always surgical. There are no medicines that can reverse or stop a cataract from forming. In some cases, if the cataract is very small and not affecting vision, doctors may monitor it without immediate surgery.

When is surgery considered?

Surgery is usually recommended as soon as possible after diagnosis, especially in very young children, to prevent lazy eye (amblyopia) and support normal vision development. The child will need to wear glasses or contact lenses after the cataract is removed.

Living with this condition

A child with cataracts may wear glasses or contact lenses to see clearly until surgery. After surgery, they will need to use corrective lenses for near and distance vision. This can be managed with proper support from an eye care team. Your child can still participate in most activities with appropriate eye protection.

Lifestyle tips

• Use glasses or contact lenses as prescribed.
• Encourage your child to wear protective eyewear during sports or rough play.
• Schedule regular eye check-ups to monitor vision changes.
• If your child is very young, work with a low vision specialist for developmental support.

Diet and exercise

A balanced diet rich in vitamins (like vitamin C and E) supports overall eye health, but no specific diet prevents or treats cataracts. Encourage safe physical activity with eye protection.

Mental health and emotional wellbeing

Living with cataracts can be stressful for both the child and family. A child may feel frustrated by poor vision or different from peers. It is important to talk openly, offer encouragement, and seek support from a child psychologist or counsellor if needed.

Prevention

Many cases of congenital cataracts cannot be prevented. However, some causes can be avoided: ensuring you are vaccinated against rubella before pregnancy, avoiding eye injuries with protective gear, and managing conditions like diabetes carefully.

Vaccines

The MMR (measles, mumps, rubella) vaccine can prevent rubella infection during pregnancy, which is a known cause of congenital cataracts.

Screening programmes

All newborns in the UK have a red reflex test within 72 hours of birth and again at 6–8 weeks. Regular vision checks throughout childhood help catch problems early.

Complications

If left untreated

• Permanent vision loss or blindness in the affected eye(s)
• Lazy eye (amblyopia), where the brain ignores input from the cloudy eye, leading to weak vision that cannot be fully corrected later
• Strabismus (eye misalignment)
• Increased risk of developing glaucoma (high pressure in the eye)

Long-term outlook

With early diagnosis and proper treatment, most children with cataracts can achieve good vision and lead a normal life. Many will need lifelong use of glasses or contact lenses. Your child’s eye care team will work with you to give them the best possible vision and support.

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