Topic Overview

A cataract is a painless, cloudy area in the lens of the eye that blocks the passage of light to the retina, the nerve layer at the back of the eye, usually causing vision problems. Cataracts are rare in babies and children. But a child may be born with them because of genetics, infection during pregnancy, or low birth weight.

The earlier cataracts are diagnosed and treated, the more likely it is that sight will be preserved or develop normally. A baby’s vision develops rapidly in the first few months of life. If a cataract blocks light from entering the eye and stimulating the retina, the area of the brain used for sight does not develop properly. And lazy eye (amblyopia) occurs. Without surgery in the first few months of life, the child won’t ever see well with that eye, even if he or she has surgery later in life.

The signs of cataracts in children include the following:

• The child may not look directly at or respond to faces or large, colorful objects. An infant who cannot find small objects when he or she is crawling on the floor may have cataracts.
• The child may scowl, squint, or shield his or her eyes more than expected when in bright sunlight. This happens because of the glare caused by a cataract.
• The child’s eyes may be misaligned and not focus on the same point at the same time (strabismus).
• You may see a white reflex instead of a red reflex in your child’s eye. For example, in a photograph of the child, one eye may appear white whereas the other has the normal “red eye” look.
• The affected eyes may have repetitive wandering movements (nystagmus). This is usually a later sign of cataracts. This sign may not develop until the infant is several months old. Removing the cataract will probably not correct all of the vision loss at this point.

If a child has a cataract in only one eye, you may not be able to tell.

Cataracts in infants are commonly detected at birth or during routine well-child checks. More frequent exams are needed if the child has a medical condition that increases the risk for cataracts, if he or she seems to have trouble seeing, or if you notice your child has clouding of the lens.

Children who have vision problems from cataracts usually need surgery to prevent lasting vision loss and to ensure normal vision will develop. A small number of children with cataracts may benefit for a short time from eyedrops that widen (dilate) the pupil. These eyedrops increase the amount of light getting into the eye. The drops may also help prevent vision loss in very young children who need to wait for surgery to be done.

Some types of cataracts in children require more urgent treatment than other types:

• Large, dense cataracts present from birth in the middle of the lens that affect only one eye are more likely to cause permanent vision loss. These cataracts need early diagnosis. And they will most likely need to be removed promptly.
• Smaller cataracts that are not causing significant vision loss and are in only one eye may be treated by patching the good eye. This strengthens sight in the eye with the cataract. Eyedrops that enlarge (dilate) the pupil may also be used to increase the amount of light getting into the eye. These treatments may prevent loss of vision until surgery can be done, if surgery is needed.
• Cataracts present from birth that cover only part of the lens and that are in both eyes are least likely to cause blindness. These cataracts may only need to be checked often by an eye specialist (ophthalmologist) to see whether they are getting larger.

Call your child’s doctor right away if you see that your child has one eye with a red reflex and one eye without it. The eye with the “white reflex” may have a cataract.

Call your child’s doctor if:

• Your baby does not look directly at or respond readily to faces or large, colorful objects by age 2 to 3 months.
• Your child scowls, squints, or shields his or her eyes more than expected when in sunlight.
• Light seems to hurt your child’s eyes.