Childhood Cataracts

Overview

A cataract is a clouding of the lens of the eye. The lens sits just behind the coloured part of the eye and normally stays clear, focusing light so the brain can see a sharp picture. When a child has a cataract, part or all of that lens turns cloudy, so light cannot get through properly and vision becomes blurred or blocked. Some children are born with a cataract (called a congenital cataract) and some develop one later in childhood. It can affect one eye or both eyes.

No. Childhood cataracts are rare. They are much less common than cataracts in older adults, which affect many people as they age. In the UK and worldwide, roughly a small number of babies in every 10,000 are born with a cataract, and a few more develop one during childhood.

Any child can be born with or develop a cataract, but it is more likely in babies born early (premature), babies who had certain infections before birth, children with a strong family history of childhood cataract, and children with some inherited or metabolic conditions. Many children with a cataract have no other health problems at all.

Symptoms

Common symptoms

• Blurred or reduced vision in one or both eyes
• Sensitivity to light or glare
• Squinting, or holding things very close to the face
• Eyes that seem to 'wobble' or move quickly and uncontrollably (called nystagmus)

Symptoms in children

• A white, grey or cloudy look in the pupil — the dark centre of the eye — which may show up in photographs taken with a flash
• A squint (one eye turning in or out)
• Not seeming to follow faces or toys by the expected age
• Not reacting to light or seeming not to see things on one side
• Tilting the head or covering one eye to see better
• Rubbing the eyes a lot, or being unusually bothered by bright light
• Falling behind at school, or struggling to see the board
• In a baby, eyes that do not make eye contact or track movement by around 6 to 8 weeks

Symptoms in older adults

• Note: this page is about cataracts in children. Adults with cataracts usually notice gradually worsening blurry vision, glare from lights, colours looking faded or yellow, and needing stronger glasses — this is a different pattern and is usually related to ageing.

Causes

Main causes

• Inherited (genetic) conditions — a cataract can run in families, and some gene changes cause cataracts on their own
• Infections caught before birth, such as rubella (German measles), toxoplasmosis, cytomegalovirus or chickenpox
• Metabolic conditions — for example, some rare disorders of how the body processes sugars or salts
• Eye injury or a blow to the eye
• Other genetic syndromes that affect how the eye or lens develops
• In many children no clear cause is ever found, which is common and not anyone's fault

Risk factors

• A parent or sibling who had a cataract in childhood
• Being born prematurely or having a low birth weight
• A mother having certain infections during pregnancy
• Some rare inherited and metabolic conditions
• Long-term use of certain medicines, including steroid-type medicines
• Previous eye injury or eye surgery
• Certain syndromes affecting the eyes or the way the body develops

When to see a doctor

See a doctor urgently if:

• You see a white or cloudy pupil, or a white glow in photographs taken with a flash
• A new squint appears, or one eye turns in or out
• Your child's vision seems to drop suddenly, or they stop reacting to things they used to see
• An eye injury, or something gets into the eye
• Eye pain, marked redness or swelling

Book a routine appointment if:

• You are worried about your child's vision, or they seem to hold things very close
• A teacher or nursery staff member mentions your child squinting or struggling to see
• There is a family history of childhood cataract and you would like your child checked
• Your child keeps tilting their head or covering one eye
• Your child is unusually bothered by bright light

Diagnosis

An eye doctor (ophthalmologist) or an optometrist will look at your child's eyes and check how well they see. The key check is looking at the red reflex — a light shone into the eye should reflect back a red-orange glow; a cataract shows up as a dark or white area. The doctor will also widen (dilate) the pupils with eye drops so the lens can be seen clearly. For babies and young children, vision is checked by watching how they follow a toy or light rather than by reading letters.

Tests that may be done

• Red reflex check with a special light
• Eye examination with dilating drops to see the lens properly
• Vision testing — picture or matching tests for young children, letter charts for older children
• Refraction — checking whether glasses are needed
• Photos or scans of the eye to look at the back of the eye and the shape of the eye
• Blood tests or a referral to a children's specialist if a genetic or metabolic cause is suspected
• Hearing and general health checks, if other conditions are being looked for

What to expect at your appointment

The eye clinic visit usually takes an hour or two. Your child may have drops that make the pupils wide for a few hours, which can sting a little and make vision blurry and light uncomfortable afterwards — sunglasses help. Your child may be seen by a team including an eye doctor, an orthoptist (a specialist in children's vision), a nurse and sometimes a children's doctor. You will normally be told the results on the day, and a plan will be agreed with you.

Treatment

The main treatment for a childhood cataract is surgery to remove the cloudy lens, followed by help to keep vision developing. Because a child's visual system is still learning to see, treatment is usually more urgent than in adults — often within weeks or a few months of being found, depending on the child's age. After surgery, your child will need glasses, contact lenses or sometimes an implanted lens to replace the focusing power, plus close follow-up.

Self-care at home

• Keep all eye clinic appointments — regular checks are how problems are spotted early
• Make sure your child wears their glasses or contact lenses as advised
• If your child needs an eye patch, follow the patching plan carefully and keep a simple diary
• Use any prescribed eye drops after surgery exactly as your care team explains
• Protect the eye from knocks and rough play in the days after surgery, as your team advises
• Tell your child's nursery or school so they can support them and make sure your child can see clearly in class
• Ask about support for your child's learning and any extra help available at school
• Encourage your child to talk about how they feel; vision problems can be tiring and sometimes upsetting

Medical treatments

Treatment is led by a specialist eye team. Surgery is the only way to remove a cataract itself. For some children, particularly older children or those with a very small cataract, the team may watch closely for a while before deciding on surgery. After surgery, vision is supported with corrective lenses (glasses or contact lenses), sometimes a small implanted lens, and 'patching' or blurring treatment of the stronger eye to encourage the weaker eye to work. Some children also need treatment for a squint or for raised pressure in the eye. Your eye team will explain what is right for your child, and any medicines will be prescribed and explained by them directly.

When is surgery considered?

Surgery is usually recommended when a cataract is affecting vision enough to threaten normal visual development. In babies, this is often done within the first few weeks or months of life, because vision develops fastest very early on. In older children, the timing depends on how much the cataract affects their sight and daily life. The operation is done under general anaesthetic and usually takes less than an hour. Many children go home the same day.

Living with this condition

Life with a child who has a cataract usually settles into a routine of clinic visits, glasses or contacts, and sometimes patching. Your child can go to nursery or school, play and take part in normal activities. The most important everyday job is keeping up with appointments and following the vision plan, because these are what give your child the best chance of good sight.

Lifestyle tips

• Make glasses or contact lenses part of the daily routine — put them on at the same time each morning
• Make patching easier with a reward chart or activities your child enjoys during patch time
• Use a sun hat or sunglasses in bright light if your child is glare-sensitive
• Tell school or nursery about your child's needs so they can sit near the front or use larger print
• Keep play safe — chat about eye protection for sports or rough games if your team advises it
• Keep a note of any changes in your child's vision between appointments
• Build in rest time — using limited vision can make children tired

Diet and exercise

No special diet or exercise plan fixes a cataract. A balanced, varied diet and plenty of normal active play help your child grow and stay well, and general eye safety — like wearing protective goggles for certain sports — is worthwhile. If your child has another condition linked to their cataract, such as a metabolic or genetic one, their specialist team may give specific dietary advice.

Mental health and emotional wellbeing

A cataract diagnosis can feel frightening for parents, and children — especially older ones — may feel anxious, self-conscious about glasses or a patch, or frustrated by clinic visits. These feelings are very common and usually ease with time and support. Talk to your eye team; they are used to helping families through this. If you or your child feel overwhelmed, low, or you have thoughts of harming yourself, contact your doctor or your local crisis service straight away — in an emergency, call your local emergency number. You do not have to cope alone.

Prevention

Not all childhood cataracts can be prevented, and some are caused by gene changes that cannot be avoided. But some causes can be reduced: making sure you are protected against rubella before pregnancy, avoiding infections during pregnancy where possible, protecting children's eyes from injury, and picking up problems early through newborn and child health checks. Early detection is the most powerful thing you can do, because it gives treatment the best chance of working.

Vaccines

Rubella (German measles) infection during pregnancy is a known cause of childhood cataract. The MMR vaccine protects against rubella and is offered to children in the UK and many other countries. If you are planning a pregnancy, ask your GP or midwife to check whether you are protected against rubella.

Screening programmes

All newborn babies in the UK have their eyes checked as part of the newborn physical examination, which includes looking for the red reflex. Eyes are checked again at the 6 to 8 week review, and vision may be checked at routine child health reviews. If your child has a family history of childhood cataract, tell your GP or midwife so extra checks can be arranged.

Complications

If left untreated

• Lazy eye (amblyopia) — the brain learns not to use the affected eye, which can cause lasting poor vision
• A squint, where one eye turns in or out
• Permanent sight loss in the affected eye
• Delayed development of visual skills such as judging distance and seeing in three dimensions
• Raised pressure inside the eye (glaucoma), which needs treatment
• Detached retina or other eye problems, which are more likely after cataract surgery and need monitoring
• Possible impact on learning and confidence if vision is not well supported

Long-term outlook

The outlook is often good, especially when a cataract is found and treated early. Many children with a childhood cataract grow up to see well, go to mainstream school and live full, active lives. The journey can involve several operations, glasses or contact lenses and years of follow-up, and every child is different. Your eye team will be honest with you about what to expect, and will work with you to give your child the best possible vision.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.