Congenital Cataracts: Types, Symptoms & Treatment

Congenital cataracts refer to a condition when the lens of the eye is cloudy or opaque at birth. This rare condition often occurs as part of other medical conditions or congenital disabilities. 

In the United States, studies show the rate of cataracts that pose a significant problem to vision is 3 to 4 per 10,000 births.

Types of Congenital Cataracts

Cataracts can occur in one or both eyes. Unilateral refers to those occurring in one eye. Bilateral refers to cataracts in both eyes.

A congenital cataract occurs when a baby is born with a cataract. Other infants develop this condition in the first six months of life, and this is termed infantile cataracts.

Unilateral congenital cataracts can affect how the brain sees. The brain may learn to switch off information from the eye with the cataract. Over time, the brain may ignore images from the eye with the cataract and favor the stronger eye. 

Bilateral cataracts can create a similar situation, where the brain ignores images from both eyes. The visual system may become limited, and some vision may be permanently reduced.

Congenital cataracts are generally removed at the earliest possible age, such as 1 to 2 months, to foster clear vision and support good brain development.

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Congenital Cataracts: Causes & Risk Factors

To understand the possible causes of this condition, it is helpful to separate unilateral from bilateral congenital cataracts. 

Unilateral cataracts have no known causes. In some cases, they may be linked to other eye problems or eye trauma, or they may be connected to an infection the baby experiences in the womb.

Bilateral cataracts are often found in families that have a history of congenital cataracts. 

These are some of the medical syndromes and disorders that are often associated with cataracts:

• Trisomy 21 syndrome
• Down’s syndrome
• Ectodermal dysplasia 
• Lowe syndrome
• Pierre-Robin syndrome

Eye injury after birth can also cause cataracts.

Infection is another possible cause of congenital cataracts. This may occur if the mother picked up certain infections, such as rubella, measles, and chickenpox, during pregnancy. 

Issues Related to Congenital Cataracts

Cataracts affect vision, creating a sense of mistiness or cloudiness. If they are not treated, they can cause further vision damage. This may contribute to the condition known as lazy eye and, in extreme cases, blindness.

For congenital cataracts, surgery is generally successful. There is a low risk of serious complications. 

In adults, cataract surgery often includes the replacement of the natural clouded lens with a man-made clear lens.

IOLs for Infants

There is controversy about the efficacy of artificial lenses, or intraocular lenses (IOL) for infants. Because the infant’s lens is changing rapidly in the first few years of life, the IOL may not be effective and can cause shortsightedness. According to RNIB, very young children with an IOL can still require very strong glasses or contact lenses as they grow.

The most common risk after surgery for a congenital cataract is posterior capsule opacification. This causes cloudy vision to return after surgery.

Increased Glaucoma Risk

There may also be an increased risk of developing glaucoma after congenital cataract surgery. A 2013 retrospective pediatrics study found that nearly two-thirds of eyes treated for congenital cataracts developed glaucoma or glaucoma symptoms within 10 years. 

Glaucoma results from an increase in pressure in the eye. Without treatment, it can irreversibly damage the eye. The same study confirms that early diagnosis and treatment may delay symptoms of glaucoma after cataract surgery.

Signs & Symptoms of Congenital Cataracts

If congenital cataracts are present, the infant may display these signs:

• Seeming to be unaware of surroundings
• Pupils appearing gray or cloudy
• Photographs not showing a red glow in the pupils
• Rapid wobbly eye movements, known as nystagmus

If a child develops cataracts, they may display these signs and symptoms:

• Difficulty recognizing objects
• Not following people with their eyes
• Eyes pointing in different directions
• Trouble seeing in bright light

It can be challenging to recognize signs of cataracts in very young children. For newborns and infants, regular eye exams are the best method of detecting cataracts.

Diagnosis of Congenital Cataracts

Most hospitals perform eye exams to screen for this condition. For instance, a baby’s eyes are examined within the first 72 hours after birth. Routine exams are also performed when the child is 6 to 8 weeks old. 

A comprehensive eye exam is the best way to diagnose a congenital cataract. If a congenital cataract is suspected on a screening, the infant will need to be examined by an ophthalmologist for an official diagnosis.

In addition, a pediatrician specializing in genetic disorders may examine the infant. Further tests such as x-rays or blood panels can help to provide a precise diagnosis.

Treatment for Congenital Cataracts

Treatment varies depending on the severity of the condition and if the cataracts are in both eyes.

Typically, if the cataracts are in both eyes, mild, and do not affect vision, treatment may not be necessary. In some cases, children who have small cataracts do not need surgery but will need to use contacts or glasses to improve vision.

If cataracts affect vision or are only present in one eye, they are often treated with surgical cataract removal. If an IOL is not used, the infant will most likely require contact lenses or eyeglasses to assist with vision. In many cases, corrective lenses are still needed even with IOL placement.

IOL placement is generally recommended for children 2 and older. It is less clear for children under 2 years old, particularly infants under 6 months old.

In some cases, a patch is worn to strengthen the weaker eye. This helps prevent amblyopia or lazy eye.

If the congenital cataract occurs as part of a genetic syndrome, the infant may also need treatment for the specific disorder. 

Prevention

If you have a family history of cataracts, it is generally not possible to prevent them from being inherited.

Evaluating your family history is recommended. If you’ve given birth to a child with congenital cataracts and are planning a future pregnancy, you may want to discuss genetic counseling with your doctor. If you have a family history of inheritable disorders, you may also want to consider genetic counseling.

Taking precautions to avoid infections is recommended for a safe pregnancy. Talk with your medical provider about getting vaccinated for certain illnesses before pregnancy and take steps to avoid infections as much as possible.

Congenital Cataracts FAQs

What is the most common cause of congenital cataracts?

The most common cause of congenital cataracts is genetics. If there are congenital cataracts in your family history, it is more likely that your child could have them. Other common infections that may cause congenital cataracts are rubella, HIV, chickenpox, herpes, and syphilis.

How common are congenital cataracts?

Cataracts in infants and children are quite rare. In the United States, approximately 3 to 4 in 10,000 infants have cataracts that impair vision.

Do congenital cataracts cause blindness?

They can. Congenital cataracts account for roughly 5 to 20 percent of cases of childhood blindness around the world. If the cataract is removed, the child’s vision can usually be restored.

References

1. Cataracts in Children, Congenital and Acquired. EyeWiki. American Academy of Ophthalmology.

2. Congenital Cataract. American Academy of Ophthalmology.

3. Congenital Cataracts. Royal National Institute of Blind People.

4. Congenital Cataract Screening. (July–September 2016). Journal of Ophthalmic & Vision Research.

5. Newborn With Bilateral Congenital Cataracts: Never Forget Congenital Rubella Syndrome. (March 2020). Paediatrics and Child Health.

6. Congenital Cataract. Mount Sinai. 

7. Intraocular Implants (IOLs). American Academy of Ophthalmology.

8. High Risk of Glaucoma After Congenital Cataract Surgery. (September 2013). American Academy of Ophthalmology.

9. Nystagmus. Mount Sinai.

10. Symptoms Childhood Cataracts. National Health Service UK. 

11. Surgery for Congenital Cataract. (2004). Community Eye Health, International Centre for Eye Health.

12. Surgeons Face Choice of Whether to Implant IOL in Pediatric Cataract Surgery. (March 2021). Ocular Surgery News.

13. Amblyopia: Types, Diagnosis, Treatment, and New Perspectives. (June 2019). American Academy of Ophthalmology.

14. Recommendations on Clinical Assessment of Patients with Inherited Retinal Degenerations. (June 2016). American Academy of Ophthalmology.

15. Congenital Cataract: a Guide to Genetic and Clinical Management. (July 2020). Therapeutic Advances in Rare Disease.

16. Risk Factors for Idiopathic Congenital/Infantile Cataract. (September 2005). Investigative Ophthalmology & Visual Science.