Childhood cataract

a) Juvenile cataract affected family shows autosomal dominant mode of transmission with three affected individuals b)image of an individual with anterior polar coronary cataract phenotype is shown
Specialty| Ophthalmology

Childhood cataract is cataract that occurs at birth or in childhood.[1] It may be congenital or acquired.

Childhood cataracts are hereditary in 8.3% to 25% of cases.[2] Of which, 75% of cases are inherited in an autosomal dominant fashion.[2] The diagnosis of childhood cataracts are associated with other eye abnormalities in 27% of cases and associated with systemic abnormalities/findings in 22% of cases.[2]

Congenital cataracts are defined as the presence of lens opacification during childhood.[3] About 1.14 million children in the world are blind.[4] Cataracts are the leading cause of blindness in children.[2]

## Contents

* 1 Signs and symptoms
* 2 Causes
* 2.1 Idiopathic
* 2.2 Hereditary
* 2.3 Metabolic
* 2.4 Congenital Infections
* 2.5 Trauma
* 3 Diagnosis
* 3.1 Medical history
* 3.2 Physical Exam
* 4 Treatment
* 4.1 Surgical Indications
* 4.2 Postoperative Care
* 5 Prognosis
* 6 Prevalence
* 7 See also
* 8 References
* 9 Further reading

## Signs and symptoms[edit | edit source]

The first sign is usually leukocoria, meaning white pupil upon fundoscopic exam.[2] Another sign is if the child has been struggling to follow objects with their eyes or has been making decreased eye contact with family members.[2] Other general complaints associated with childhood cataracts include kids squeezing their eyes shut in response to bright lights, squinting of eyes, history of small set eyes or large set eyes, and nystagmus.[2] Older kids are more likely to complain of the following: difficulty viewing objects at a distance, unable to view whiteboard in class, parent may notice children are bringing objects closer to their face.[2]

## Causes[edit | edit source]

There are several causes of childhood cataracts.[3][2] A few of these causes are detailed below.

### Idiopathic[edit | edit source]

Most cases of childhood cataracts, both unilateral and bilateral, are idiopathic in nature.[3][2]

### Hereditary[edit | edit source]

Congenital cataracts are typically inherited in an autosomal dominant pattern with incomplete inheritance.[2] There are multiple different genetic disorders associated with congenital cataracts: Norrie disease (X-linked recessive inheritance), Nance-Horan syndrome (X-linked recessive inheritance), Down's syndrome (also associated with other eye abnormalities like nystagmus and strabismus), and Lowe syndrome (X-linked inheritance).[2]

### Metabolic[edit | edit source]

One specific metabolic disorder associated with congenital cataracts is Galactosemia.[2]

### Congenital Infections[edit | edit source]

Congenital infections include Toxoplasma, Rubella, Cytomegalovirus (CMV), Herpes, and Syphilis.[2] The most common congenital infection to cause congenital cataracts is Rubella.[2] Rubella is especially common, with a higher incidence in India.[2] Rubella is characterized by a triad of features: congenital cataracts, sensorineural hearing loss, and patent ductus arteriosus (a congenital heart condition).[2]

### Trauma[edit | edit source]

Trauma can cause cataracts in childhood.[3][2] There are different types of traumatic injury that cause cataracts in different parts of the world. Child abuse may cause traumatic injury to the eye and cataracts.[3] Open globe injuries are more often associated with cataracts than closed globe injuries.[2] The leading cause of these open globe injuries are bow and arrow injuries.[2]

## Diagnosis[edit | edit source]

Cataracts in childhood are often detected via routine screening.[2]

### Medical history[edit | edit source]

Routine screening is the method in which cataracts are typically diagnosed in childhood.[2] A thorough history is obtained to assist in making this diagnosis.[2] The following are questions to consider addressing in a visit: "at what age did the symptoms begin?", "how long have the symptoms been present?", "is there a family history of childhood cataracts?", "is there a history of pregnancy complications or symptoms?", "any drug use during pregnancy?", "is there history of trauma during pregnancy?", "does the child have any other accompanying symptoms like vomiting?".[2] A specific question regarding vomiting is asked as it may lead to increased suspicion for Galactosemia.[2]

### Physical Exam[edit | edit source]

A complete physical examination is done to identify if a child has any associated systemic symptoms which may aid in a diagnosis of childhood cataracts.[2] In addition, a complete eye examination is done.[3][2] This eye exam includes fixation, pupillary reflex test, and test for visual acuity.[2] Visual acuity is tested differently based on patient's age. For infants, visual acuity can be tested by visual evoked response, Catford drum, optokinetic nystagmus, and Teller's acuity cards tests.[2] For children aged 1–2 years old, visual acuity can be tested by Worth's ivory ball test, Boeck's candy test, the "Screening Test for Young Children and Retards", and Cardiff's acuity test.[2] For children aged 2–3 years old, visual acuity can be tested by miniature toy test, coin test, and LEA symbols tests.[2] For children aged 3–5 years old, visual acuity can be tested by Allen's picture card, Lippman's HOTV test, and letter test.[2] For children greater than age 5, visual acuity can be tested by Tumbling E, Landolt's broken ring, Snellen's chart, and LogMAR chart tests.[2]

## Treatment[edit | edit source]

Early detection is crucial in treatment of congenital cataracts.[3][5] Prognosis is good if cataracts are detected early and surgery occurs aged 6 weeks for unilateral cataracts and at 8 weeks for bilateral cataracts.[5] Favorable outcomes are associated with timely surgery, appropriate postoperative care, and visual rehabilitation postoperatively.[2] Postoperative care requires effective communication between an interdisciplinary team including parents, pediatricians, surgeons, anesthesiologists, and optometrists.[2]

In order to decrease presentations of avoidable blindness in childhood, it is important to focus on maternal and neonatal health prior to symptomatic presentation.[4]

### Surgical Indications[edit | edit source]

There are multiple indications for cataract surgery.[3] An absolute indication signifies need for surgical correction.[3] Surgical correction of the cataract is indicated when lens opacification blocks the ref reflex and dilated pupils are detected, strabismus with unilateral cataract, or nystagmus with bilateral cataracts.[3]

### Postoperative Care[edit | edit source]

After surgery, postoperative care is necessary for recovery.[3] Topical corticosteroids are used to decrease postoperative optical inflammation.[3] Topical antibiotics are used to decrease risk of infection after surgery.[3] Topical anesthetics are used for postoperative pain.[3] Contact lens are used immediately after surgery to allow for visual rehabilitation.[3] Visual rehabilitation decreases risk of strabismus, amblyopia, and poor fusion after cataract surgery.[3]

## Prognosis[edit | edit source]

Untreated childhood cataracts can cause emotional, financial, and societal burdens.[2] Even when treated, childhood cataracts may be associated with some complications.[3] About 10% to 25% of children have been diagnosed with glaucoma after cataract surgery.[3][2] The most common complication after cataract surgery in childhood is visual axis opacification.[3][2] Cataract surgery may be associated with decreased accommodation.[3]

## Prevalence[edit | edit source]

Childhood cataracts are the primary cause of childhood blindness.[2] Childhood cataracts make up 7.4% to 15.3% of blindness in kids.[2] The prevalence of childhood cataracts ranges from 0.63/10,000 to 9.74/10,000 children, with a median of 1.71.[6] This is dependent on factors like economic status but not gender or laterality.[6] The incidence of childhood cataracts ranges from 1.8/10,000 to 3.6/10,000 children per year.[6]

## See also[edit | edit source]

* Blindness
* Cataract
* Cataract Surgery

## References[edit | edit source]

1. ↑ Medsinge, Anagha; Nischal, Ken K. (2015-01-01). "Pediatric cataract: challenges and future directions". Clinical Ophthalmology. Auckland, N.Z. 9: 77–90. doi:10.2147/OPTH.S59009. ISSN 1177-5467. PMC 4293928. PMID 25609909.
2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 2.33 2.34 2.35 2.36 2.37 2.38 2.39 Khokhar, Sudarshan Kumar; Pillay, Ganesh; Dhull, Chirakshi; Agarwal, Esha; Mahabir, Manish; Aggarwal, Pulak (December 2017). "Pediatric cataract". Indian Journal of Ophthalmology. 65 (12): 1340–1349. doi:10.4103/ijo.IJO_1023_17. ISSN 1998-3689. PMC 5742962. PMID 29208814.
3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 Mohammadpour, Mehrdad; Shaabani, Amirreza; Sahraian, Alireza; Momenaei, Bita; Tayebi, Fereshteh; Bayat, Reza; Mirshahi, Reza (June 2019). "Updates on managements of pediatric cataract". Journal of Current Ophthalmology. 31 (2): 118–126. doi:10.1016/j.joco.2018.11.005. ISSN 2452-2325. PMC 6611931. PMID 31317088.
4. ↑ 4.0 4.1 Gilbert, Clare; Bowman, Richard; Malik, Aeesha Nj (2017). "The epidemiology of blindness in children: changing priorities". Community Eye Health. 30 (100): 74–77. ISSN 0953-6833. PMC 5820629. PMID 29483749.
5. ↑ 5.0 5.1 Bremond-Gignac, Dominique; Daruich, Alejandra; Robert, Matthieu P.; Valleix, Sophie (November 2020). "Recent developments in the management of congenital cataract". Annals of Translational Medicine. 8 (22): 1545. doi:10.21037/atm-20-3033. ISSN 2305-5839. PMC 7729375. PMID 33313290.
6. ↑ 6.0 6.1 6.2 Sheeladevi, S; Lawrenson, J G; Fielder, A R; Suttle, C M (September 2016). "Global prevalence of childhood cataract: a systematic review". Eye. 30 (9): 1160–1169. doi:10.1038/eye.2016.156. ISSN 0950-222X. PMC 5023808. PMID 27518543.

## Further reading[edit | edit source]

* Childhood cataracts Archived 2017-09-29 at the Wayback Machine at NHS Choices
* Cataracts in Children, Congenital and Acquired Archived 2023-04-11 at the Wayback Machine at EyeWiki

* v
* t
* e

* Diseases of the human eye

Adnexa

| Eyelid|

| Inflammation|

* Stye
* Chalazion
* Blepharitis
* Meibomian gland dysfunction

|

* Entropion
* Ectropion
* Lagophthalmos
* Blepharochalasis
* Ptosis
* Blepharophimosis
* Xanthelasma
* Ankyloblepharon

Eyelash|

* Trichiasis
* Madarosis

Lacrimal apparatus|

* Dacryoadenitis
* Epiphora
* Dacryocystitis
* Xerophthalmia

Orbit|

* Exophthalmos
* Enophthalmos
* Orbital cellulitis
* Orbital lymphoma
* Periorbital cellulitis

Conjunctiva|

* Conjunctivitis
* allergic
* Pterygium
* Pseudopterygium
* Pinguecula
* Subconjunctival hemorrhage

Globe

| Fibrous tunic|

| Sclera|

* Scleritis
* Episcleritis

|

Cornea|

* Keratitis
* herpetic
* acanthamoebic
* fungal
* Exposure
* Photokeratitis
* Corneal ulcer
* Thygeson's superficial punctate keratopathy
* Corneal dystrophy
* Fuchs'
* Meesmann
* Corneal ectasia
* Keratoconus
* Pellucid marginal degeneration
* Keratoglobus
* Terrien's marginal degeneration
* Post-LASIK ectasia
* Keratoconjunctivitis
* sicca
* Corneal opacity
* Corneal neovascularization
* Kayser–Fleischer ring
* Haab's striae
* Arcus senilis
* Band keratopathy

Vascular tunic|

* Iris
* Ciliary body

* Uveitis
* Intermediate uveitis
* Hyphema
* Rubeosis iridis
* Persistent pupillary membrane
* Iridodialysis
* Synechia

|

Choroid|

* Choroideremia
* Choroiditis
* Chorioretinitis
* Focal choroidal excavation
* Polypoidal choroidal vasculopathy

Lens|

* Cataract
* Congenital cataract
* Childhood cataract
* Aphakia
* Ectopia lentis

Retina|

* Retinitis
* Chorioretinitis
* Cytomegalovirus retinitis
* Retinal detachment
* Retinoschisis
* Ocular ischemic syndrome / Central retinal vein occlusion
* Central retinal artery occlusion
* Branch retinal artery occlusion
* Retinopathy
* diabetic
* hypertensive
* Purtscher's
* of prematurity
* Bietti's crystalline dystrophy
* Coats' disease
* Sickle cell
* Macular degeneration
* Retinitis pigmentosa
* Retinal haemorrhage
* Central serous retinopathy
* Macular edema
* Epiretinal membrane (Macular pucker)
* Vitelliform macular dystrophy
* Leber's congenital amaurosis
* Birdshot chorioretinopathy

Other|

* Glaucoma / Ocular hypertension / Primary juvenile glaucoma
* Floater
* Leber's hereditary optic neuropathy
* Ocular hypotony
* Red eye
* Globe rupture
* Keratomycosis
* Phthisis bulbi
* Persistent fetal vasculature / Persistent hyperplastic primary vitreous
* Persistent tunica vasculosa lentis
* Familial exudative vitreoretinopathy

Pathways

| Optic nerve
Optic disc|

* Optic neuritis
* optic papillitis
* Papilledema
* Foster Kennedy syndrome
* Optic atrophy
* Optic disc drusen

Optic neuropathy|

* Ischemic
* anterior (AION)
* posterior (PION)
* Kjer's
* Leber's hereditary
* Toxic and nutritional

Strabismus
Extraocular muscles
Binocular vision
Accommodation|

| Paralytic strabismus|

* Ophthalmoparesis
* Chronic progressive external ophthalmoplegia
* Kearns–Sayre syndrome

palsies|

* Oculomotor (III)
* Fourth-nerve (IV)
* Sixth-nerve (VI)

Other strabismus|

* Esotropia / Exotropia
* Hypertropia
* Heterophoria
* Esophoria
* Exophoria
* Cyclotropia
* Brown's syndrome
* Duane syndrome

Other binocular|

* Conjugate gaze palsy
* Convergence insufficiency
* Internuclear ophthalmoplegia
* One and a half syndrome

Refraction|

* Refractive error
* Hyperopia
* Myopia
* Astigmatism
* Anisometropia / Aniseikonia
* Presbyopia

Vision disorders
Blindness|

* Amblyopia
* Leber's congenital amaurosis
* Diplopia
* Scotoma
* Color blindness
* Achromatopsia
* Dichromacy
* Monochromacy
* Nyctalopia
* Oguchi disease
* Blindness / Vision loss / Visual impairment

Anopsia|

* Hemianopsia
* binasal
* bitemporal
* homonymous
* Quadrantanopia

subjective|

* Asthenopia
* Hemeralopia
* Photophobia
* Scintillating scotoma

Pupil|

* Anisocoria
* Argyll Robertson pupil
* Marcus Gunn pupil
* Adie syndrome
* Miosis
* Mydriasis
* Cycloplegia
* Parinaud's syndrome

Other|

* Nystagmus
* Childhood blindness

Infections

* Trachoma
* Onchocerciasis

* v
* t
* e

Optical illusions (list)

Illusions|

* Afterimage
* Ambigram
* Ambiguous image
* Ames room
* Autostereogram
* Barberpole
* Bezold
* Café wall
* Checker shadow
* Chubb
* Cornsweet
* Delboeuf
* Ebbinghaus
* Ehrenstein
* Flash lag
* Fraser spiral
* Gravity hill
* Grid
* Hering
* Impossible trident
* Irradiation
* Jastrow
* Lilac chaser
* Mach bands
* McCollough
* Müller-Lyer
* Necker cube
* Oppel-Kundt
* Orbison
* Penrose stairs
* Penrose triangle
* Peripheral drift
* Poggendorff
* Ponzo
* Rubin vase
* Sander
* Schroeder stairs
* Shepard tables
* Spinning dancer
* Ternus
* Vertical–horizontal
* White's
* Wundt
* Zöllner

Popular culture|

* Op art
* Trompe-l'œil
* Spectropia (1864 book)
* Ascending and Descending (1960 drawing)
* Waterfall (1961 drawing)
* The dress (2015 photograph)

Related|

* Accidental viewpoint
* Auditory illusions
* Illusions
* Tactile illusions
* Temporal illusion

*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template