When Surgery Is Needed for Congenital Cataracts

Congenital cataracts are a condition in which a baby is born with clouding in the eye’s lens or develops it shortly after birth. While cataracts are commonly associated with aging, cataracts in infants and children require a different approach.

Because vision plays a critical role in early development, congenital cataracts must be identified and managed promptly to support healthy visual growth. Understanding when monitoring is appropriate, and when surgery is necessary, can help parents make informed decisions about their child’s eye care.

Cataracts in the eyes occur when the normally clear lens inside the eye becomes cloudy, preventing light from passing through properly. This cloudy lens can interfere with how images are focused on the retina, leading to changes in vision.

Common cataract symptoms include cloudy vision, sensitivity to light, double vision, and difficulty seeing clearly. The symptoms of cataracts can vary depending on the size and location of the lens clouding and whether one or both eyes are involved.

Cataracts are often identified during a comprehensive eye exam, where changes in lens clarity can be observed and cataracts diagnosed. When cataracts affect only one affected eye, vision differences between the eyes may become noticeable.

Congenital cataracts occur when the normally clear lens of the eye becomes cloudy at birth or during early infancy. The eye’s lens plays a crucial role in focusing light onto the retina, allowing the brain to receive clear visual signals. When the lens becomes clouded, light cannot pass through efficiently, leading to blurred or distorted vision.

Congenital cataracts may affect one eye or both eyes, and their severity can vary widely. Some are small and located away from the visual axis, while others are dense and centrally positioned, significantly interfering with vision. The degree to which a cataract affects sight often determines whether treatment involves close monitoring or surgical intervention.

Congenital cataracts may sometimes be visible to parents or caregivers, though early cataracts can be subtle. One of the most noticeable signs is a white or cloudy appearance in the pupil instead of the typical black color. This may be observed during routine newborn screenings or in photographs where one eye lacks a normal red reflex.

In some cases, a baby’s eyes may not track objects properly, or one eye may appear to drift or move abnormally. Early cataracts may not be obvious at first, which is why regular infant eye exams are important. Early detection allows eye doctors to determine whether the cataract poses a risk to visual development.

Congenital cataracts are classified based on their location within the lens and their density. Common types include:

Nuclear cataracts: Form in the center of the lens.

Cortical cataracts: Develop along the outer edges

Posterior subcapsular cataracts: Form at the back of the lens and often interfere with vision more significantly.

Some congenital cataracts are partial, allowing some light to pass through, while others are dense and block most incoming light. The type and density of the cataract help guide treatment decisions, as more visually significant cataracts are more likely to require surgery.

Unlike age-related cataracts, which typically progress slowly over many years, congenital cataracts can interfere with vision at a critical time in development. During infancy and early childhood, the visual system is still forming. If clear visual input is blocked, the brain may not learn to process visual information correctly.

Because of this, even cataracts that might seem small can have a lasting impact on vision if they affect the visual axis. Early cataracts in adults often allow time for monitoring, but congenital cataracts require a more urgent and individualized approach.

Congenital cataracts can develop for several reasons, and in many cases, more than one factor may be involved.

• Genetic conditions: Inherited genetic abnormalities are one of the most common causes of congenital cataracts, particularly when cataracts affect both eyes.

• Family history of cataracts: Children with a family history of congenital or early-onset cataracts may have a higher risk of developing the condition.

• Infections during pregnancy: Certain maternal infections, such as rubella, can interfere with normal lens development and lead to early cataract formation in the baby’s eyes.

• Metabolic or systemic medical conditions: Disorders affecting metabolism or overall health can disrupt normal lens clarity during fetal development.

• Abnormal lens development: In some cases, the lens does not form properly during pregnancy, resulting in clouding at birth or shortly afterward.

• Idiopathic causes: For many children, no clear cause is identified, and the cataracts develop without an obvious underlying condition.

The signs of cataracts can vary depending on the size, location, and density of the cataract, as well as whether one or both eyes are affected.

• Cloudy or white appearance in the pupil: Instead of appearing black, the pupil may look white or cloudy, indicating that the lens is not clear.

• Poor visual tracking: Infants may have difficulty following faces or objects with their eyes, which can signal impaired visual input.

• Abnormal eye movements: Some children may develop involuntary eye movements or misalignment as the visual system struggles to compensate.

• Sensitivity to light: Bright light may cause discomfort or squinting, particularly when the lens cannot properly filter incoming light.

• Delayed visual development: Untreated cataracts can interfere with normal visual milestones, affecting how the brain learns to process visual information.

• Vision problems as the child grows: Older children may have difficulty with everyday activities that require clear vision. Blurry vision and other eye problems may make activities such as reading or recognizing objects difficult.

Because infants cannot communicate visual difficulties and health problems, careful observation and routine eye exams are essential.

Congenital cataracts are often detected during newborn vision screenings or routine pediatric exams. If an abnormal red reflex or other visual concern is identified, a comprehensive dilated eye exam is performed by an eye doctor, often a pediatric ophthalmologist.

The examination allows the doctor to assess the lens, retina, and overall eye health. Additional testing or imaging may be used to evaluate the extent of the cataract and rule out other eye conditions. Early diagnosis is critical for preventing long-term vision loss.

Surgery is considered when a congenital cataract significantly interferes with vision or blocks light from reaching the retina. Several factors influence this decision, including the size and density of the cataract, whether one or both eyes are affected, and how much the cataract disrupts visual development.

Dense cataracts that obstruct the visual axis often require surgery to prevent permanent vision impairment. In cases where only one eye is affected, early intervention is especially important to reduce the risk of amblyopia, or “lazy eye.”

Milder cataracts that do not interfere with vision may be monitored closely with regular exams. The decision to proceed with eye surgery is individualized and based on careful evaluation of the child’s visual needs.

Treatment depends on the severity of the cataract and its impact on vision. Mild cataracts that do not block vision may only require observation and regular follow-up exams to ensure they do not progress.

When surgery is needed, the clouded lens is removed to restore a clear visual pathway. Depending on the child’s age and eye development, vision correction may involve contact lenses or, in some cases, an artificial lens.

After surgery, ongoing visual rehabilitation - including glasses, contact lenses, or patching therapy - may be necessary to support proper visual development. Long-term follow-up is essential, as children who undergo cataract surgery require continued monitoring as their eyes grow and change.

Most congenital cataracts cannot be prevented, especially those caused by genetic or developmental factors. While there is no way to prevent cataracts, prenatal care and infection screening during pregnancy can reduce certain risks and serious complications.

Because prevention is not always possible, early diagnosis and timely treatment play the most important role in protecting vision. Routine newborn screenings and prompt referral to an eye specialist help ensure the best possible outcomes. Routine eye exams also help monitor for developing cataracts and other eye conditions.