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A congenital cataract occurs when the eye’s natural lens becomes cloudy either at birth or soon after. Although this is uncommon, congenital cataracts are among the main causes of preventable vision loss in children. Cataracts in adults usually develop slowly over time and can be treated at any age.
Congenital cataracts are different because they affect vision during the first and most important stages of a child’s visual development. A baby’s brain learns how to see in the first weeks and months of life. If the image reaching the brain is unclear during this time, permanent vision problems can develop if the cataract is not treated promptly.
Why Congenital Cataracts Matter
In adults, a cataract usually just causes blurry vision. In babies, though, this blurring can stop the visual pathway from developing properly. If a cataract blocks the center of the lens during the early weeks or months, the brain may not learn to see from that eye. Even if surgery is done later, the eye might not reach normal vision if the cataract was not treated early enough.
For this reason, early diagnosis of congenital cataracts is essential. Most infants with significant cataracts require surgery within the first 6 to 10 weeks of life. Early treatment allows the brain to receive clear visual signals, which supports normal visual development.
Why Cataracts Develop Before Birth
The lens of the eye begins to form early in pregnancy through a complex process. Even minor disruptions during this time, such as genetic changes, infections, or metabolic problems, can affect the lens’s clarity.
Some of the more common causes include:
1. Genetic factors
Many congenital cataracts are inherited and can run in families. Some affect only the eyes, while others are part of a larger genetic condition. Often, the inheritance is autosomal dominant, which means that if one parent has the condition, it can be passed on to the child.
Examples of syndromes that may include cataracts:
- Down syndrome
- Marfan syndrome and Weill-Marchesani syndrome
- Stickler syndrome
- Lowe syndrome
- Myotonic dystrophy
2. Infections during pregnancy
Certain infections can cross the placenta during pregnancy and affect the baby’s developing lens. The TORCH group of infections includes toxoplasmosis, syphilis, rubella, cytomegalovirus, and herpes.
Rubella infection during early pregnancy is still one of the most important infectious causes of congenital cataracts.
Rubella infection during early pregnancy is still one of the most important infectious causes of congenital cataracts.
3. Metabolic disorders
Some systemic diseases can cause cataracts to develop quickly in newborns.
Examples include:
Examples include:
- Galactosemia (a metabolic emergency that must be treated immediately)
- Hypocalcemia
- Certain amino acid disorders
- Rare forms of neonatal diabetes
It is important to find these conditions as early as possible. Treating the underlying disease can help protect the eyes and prevent further problems elsewhere in the body.
How Congenital Cataracts Appear
Parents are usually the first to notice when something seems unusual about their baby’s eyes. There are certain signs that should be checked by an eye doctor as soon as possible:
- A white or dull reflection in the pupil, sometimes called a white pupil in photographs.
- Eyes that do not seem to follow faces or moving objects
- Abnormal eye movements (nystagmus)
- One eye is turning inward or outward.
- A baby who does not seem interested in looking at people or things around them
If you notice any of these signs, it is important to have your child examined by an eye doctor right away.
How Doctors Diagnose the Condition
Examining a newborn’s eyes requires patience and special skills. The eye doctor will check the red reflex, examine the lens with magnification to assess how well light reaches the retina, and examine the rest of the eye.
Additional tests may include:
- Ultrasound, if the cataract blocks the view of the retina
- Blood work to rule out infections or metabolic disorders
- Genetic testing, when appropriate
- Electrophysiology tests (ERG/VEP) are performed if retinal or optic nerve disease is suspected.
A detailed medical history is also important. The doctor will ask about the pregnancy, the delivery, and whether anyone in the family has had cataracts at a young age. This information helps guide the next steps in care.
Different Types of Congenital Cataracts
Not all cataracts are the same. Where the cataract is located in the lens can affect how much it impacts vision and what treatment is needed.
Examples include:
- Total cataract: The whole lens is cloudy. Surgery is needed quickly.
- Nuclear cataract: The lens nucleus is cloudy. This type is often inherited.
- Lamellar (zonular) cataract: Cloudiness forms in concentric rings around the lens center.
- Cerulean cataract: Small blue-white spots in the lens. These are often stable and may not change much over time.
- Posterior polar cataract: A dense, cloudy area at the back of the lens. This type can be more difficult to treat with surgery.
- Anterior polar cataract: A small spot at the front of the lens. This type is often harmless.
The type of cataract can help doctors predict how your child’s vision may develop as they grow.
Treatment: When Surgery Is Needed
Some cataracts are small and do not block the main visual pathway. These cases can often be monitored closely without immediate surgery.
However, if the cataract affects vision, even to a small degree, prompt action is important.
However, if the cataract affects vision, even to a small degree, prompt action is important.
Here are some general guidelines for when surgery may be needed:
- Unilateral dense cataract: Ideally, before 6 weeks
- Bilateral dense cataracts: Usually by 8 to 10 weeks
- Partial cataracts: Monitored; surgery if visual clarity drops
How surgery works
Cataract surgery in infants differs from surgery in adults. The lens in a baby’s eye is softer, the tissues heal differently, and there is a higher risk of inflammation. Most surgeries involve the following steps:
- A small corneal or limbal incision
- Removal of the cloudy lens material
- Creating an opening in the back of the capsular bag
- A limited anterior vitrectomy (to prevent secondary opacification)
- Placement of an intraocular lens (IOL) when appropriate
Very young babies may not get a full-strength artificial lens because their eyes are still growing. Using a weaker lens helps the eye develop normal focusing ability as your child grows.
After Surgery: The Real Work Begins
Restoring clarity to the eye is only the first step. After surgery, the brain must learn to use the eye, making regular follow-up care essential.
It includes:
- Anti-inflammatory and antibiotic eye drops.
- Frequent follow-up visits to check pressure and healing
- Glasses or contact lenses to replace the natural lens power
- Amblyopia therapy (patching) to strengthen the operated eye
Helping your child’s vision develop after surgery can take years, but it is very important for the best possible outcome.
Possible Complications
Even with the best surgical care, children with congenital cataracts can still face long-term risks, including:
- Glaucoma (can appear months or years later)
- Recurrent clouding of the visual axis
- Inflammation and membrane formation
- IOL displacement
- Retinal detachment (rare)
Because of these possible problems, children who have had cataract surgery need regular eye check-ups for the rest of their lives.
Outlook for Children With Congenital Cataracts
When congenital cataracts are found early and treated properly, many children can achieve good or even excellent vision. Children with cataracts in both eyes often do better than those with cataracts in only one eye because both eyes develop together.
The final vision also depends on whether there are other eye problems, how soon surgery is done, and how well amblyopia treatment is followed.
Parents play a very important role in helping their child achieve the best possible vision after cataract surgery.
Can Congenital Cataracts Be Prevented?
Not all congenital cataracts can be prevented, but some types can.
Helpful preventive steps include:
- Maternal rubella vaccination before pregnancy
- Proper prenatal care
- Screening for infections
- Red reflex testing before newborn discharge
- Genetic counseling for families with inherited cataracts
Finding cataracts early is still the best way to protect your child’s vision.
FAQs
1. Can congenital cataracts come back after surgery?
The cataract itself doesn’t grow back, but some babies develop a new cloudy layer behind the artificial lens weeks or months after surgery. This is called visual axis opacification (VAO). It’s very common in infants because their eyes are still developing. If it happens, the doctor may need to clear the cloudy tissue with a short procedure so light can reach the retina again.
2. Are congenital cataracts always easy for parents to spot?
Not always. Some cataracts are tiny or sit off to the side of the lens, so they’re hard to see with the naked eye. Instead of noticing a white pupil, parents might see that the baby isn’t following faces or that one eye is drifting inward. This is why newborns should always get a red reflex test before leaving the hospital; it detects cataracts that parents can’t see.
3. Do children with congenital cataracts grow and learn normally?
Most do very well, especially when the cataract is treated early, and families keep follow-up appointments. Vision development still needs support, though. Many children will use glasses, contact lenses, or patching for several years to help both eyes learn to work properly. With this support, they typically keep up in school and daily activities just like other children.
4. Can congenital cataracts be connected to other health issues?
Sometimes, yes. In certain babies, the cataract is actually the first clue that something else is going on, such as a genetic condition, a metabolic disease, or an infection the mother had during pregnancy. Because of this, doctors often involve a team of specialists to make sure nothing important is missed.
5. Is cataract surgery safe for infants?
Although surgery on a tiny eye sounds delicate, pediatric cataract surgery is very safe in experienced hands. The biggest challenges usually come after surgery, such as inflammation, glaucoma, or the visual axis becoming cloudy again. That’s why careful, long-term follow-up is just as important as the surgery itself.
