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Cataracts in Children

By Cashmere Lashkari

Cataracts are usually associated with old age and diminishing eyesight. However, it is possible for a child to be born with a cataract as well as to develop it over time. If your child is having trouble seeing things, you may want to get their eyes tested so that timely and appropriate medical treatment can be provided.

What is a Cataract?

The lens of the eye is located behind the pupil. It allows light to pass through the eye to the retina located at the back of the eye. When this lens becomes cloudy or opaque, it doesn’t allow light to enter the eye properly. This causes the light rays to scatter and the image formed on the retina is blurred or distorted.

If the light scattering opacity of the lens is present from birth, it is called a congenital cataract. If it develops over course of time, it is called acquired cataract. One in 250 children will develop a cataract either prior to birth or during their childhood. The condition is often hereditary, so family history should be considered.

How is a Cataract Formed in Children?

There is no identifiable cause as yet for congenital cataract. Researchers suspect that the infantile cataract is caused by genetic mutation. Close to fifteen genes associated with cataract formation are being studied to gain further insight into the condition. It has been found to often come from an autosomal dominant gene from a single parent.

Cataract may also be formed due to intrauterine infections such as rubella, herpes simplex, toxoplasmosis, varicella, and syphilis. Bilateral cataracts affecting both the eyes have been associated with a number of other genetic disorders. Unilateral cataract may be developed due to a disease or infection the child picks up or could be caused by trauma.

Diagnosis of Cataract in Children

Since congenital cataract is usually genetic in nature, there is bound to be family history of the disorder. A careful account of prenatal and pregnancy history should be kept in such cases. The doctor may perform a visual acuity test on the child to check how well he can see at different distances.

Eye drops may be used to dilate the child’s pupils to examine the back of the eye. An ultrasound may be performed to check the eye. The cataract will be studied to check how much of the lens it affects. A partial cataract that is small in size and away from the centre of the lens may not need to be removed. However, in most cases, lens replacement surgery is performed.

Treatment for Cataract in Children

If the cataract is not having too bad an effect on the vision of the child, the doctor will not recommend surgery. However, if it will affect the normal growth of the eye and cause impairment in sight development, surgery will be needed to remove the affected lens and replace it with an artificial one.

In some cases, the lens may not be implanted in the child as the eye will grow and the lens may become inadequate. Here the child will be asked to wear contact lenses or glasses to correct the error caused by the removal of the cataract lens. For congenital bilateral cataracts, surgery is recommended within two months of life.

Complications and Risk Factors to Consider

There is no way to prevent cataract and so taking care to get timely treatment is the best way to manage it. Cataract cause poor vision as well as wandering of the eye. This is a complication that can stress the eye muscles. Botox injections may be required along with surgery if the eye muscles are getting strained due to cataract.

Children with cataracts are more likely to develop glaucoma, or high blood pressure in the eye. This complication can be treated with medication, but may sometimes require surgery. Surgery increases the risk of infection, inflammations, retinal detachment, and displacement of intra-ocular lens. The surgery must be performed with great care to avoid additional complications.

Recovery from Childhood Cataracts

Once the lens affected with cataract is removed, the vision will be extremely blurry. This is corrected in three possible ways using contact lenses, eye glasses, and with an intra-ocular lens. These artificial lenses enable the child to see clearly.

While an intra-ocular lens is seen as a permanent solution to the problem, the doctor may advice not to implant one in the child during the cataract surgery. This is because it is difficult to predict the power of the lens the child will need in adulthood. In such cases, a second surgery is conducted once the child has grown up to implant the lens.

The general prognosis of treatment is quite good. Childhood cataract if treated in time is not a problem to good eye sight in the adult years. Surgical intervention of a timely nature can save the vision of the child from further deteriorating.

Reviewed by Susha Cheriyedath, MSc

References

Further Reading

Last Updated: Nov 23, 2016

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