Congenital Cataracts

What Are Congenital Cataracts?

A cataract is any clouding or opacity of the lens of an eye. Congenital means that it happens before birth or during a baby's first year of life. A baby with congenital cataracts has clouding in one or both eyes.

What Happens if a Baby Has Congenital Cataracts?

A baby with a cataract can't see well through the affected eye. This makes it hard for the brain and eyes to work together, which they must do to develop normal sight and properly control eye movements.

What Other Problems Can Happen?

Depending on the cause of a cataract and how big it is, a baby with a congenital cataract can have other eye problems, including:

• some vision loss (called "lazy eye" or amblyopia)
• a rip (tear) in the light-sensitive layer in the back of the eye (retinal detachment)
• one eye that doesn't line up with the other (strabismus)
• pressure buildup inside the eye that leads to optic damage (glaucoma)

What Are the Signs & Symptoms of Congenital Cataracts?

When a baby has a congenital cataract, the center (pupil) of the eye looks gray or white instead of black. The whole pupil may look like it is covered with a film, or you might see a white spot within the pupil.

What Causes Congenital Cataracts?

Cataracts happen when proteins in the eye's lens change. They may change because of an infection, a change in DNA, or a chemical imbalance.

Congenital cataracts can happen in babies who:

• had an infection before or soon after birth
• have a family history of congenital cataracts
• were born early (premature)

The most common infections that cause congenital cataracts include:

• chickenpox
• cytomegalovirus
• herpes
• HIV
• rubella
• syphilis
• toxoplasmosis

Many babies who develop congenital cataracts don't have other medical problems. In a lot of cases, a cause is not found. 

How Are Congenital Cataracts Diagnosed?

Doctors often diagnose congenital cataracts during the newborn exam after a baby is born. Other times, they're diagnosed during a well-child checkup, or after a parent notices one of the baby's eyes doesn't look right.

The doctor will refer the baby to an eye surgeon (ophthalmologist) who specializes in treating children. The doctor also will check for signs of other problems that sometimes happen in babies with cataracts. The baby will get a thorough eye exam.

How Are Congenital Cataracts Treated?

Ophthalmologists do surgery to remove congenital cataracts in some cases. Some congenital cataracts do not need surgery. When the baby's vision is affected, surgery usually happens soon after the diagnosis, as early as 6–8 weeks of age. During the procedure, the ophthalmologist removes the cloudy part of the lens and may put in a flexible plastic artificial lens implant.

After the surgery, the baby usually will need to wear a contact lens or glasses to help the eye focus properly. Some babies will also wear an eye patch to help with the brain's visual development. 

How Can Parents Help?

Kids who have had congenital cataracts removed may have other eye problems. Careful and complete follow-up is important.

To help your child:

• Take your child to all well-child checkups and ophthalmologist visits.
• If your child is treated with:
  • Contact lenses: Follow the cleaning and wearing schedule. Tell your baby's doctor if you have trouble with the contact lens routine.
  • Medicines (including eye drops): Give them on time, every time. Renew prescriptions before they run out. Talk to the pharmacist or your doctor if you're not sure how to give a medicine.
  • Glasses: Encourage your child to wear them as directed. Go to all medical visits so the prescription can be updated. 
• Tell the doctor if other people in your family have (or had) cataracts. If your child's cataracts are due to a genetic (DNA) condition, ask about genetic counseling for your family and for your child, when they reach adulthood.