Cataract Surgery in Children: Symptoms, Causes, Procedure, Risk and Recovery

Cataract surgery in children is a delicate procedure that can restore a child’s vision. Learn about the procedure, risks, recovery, and more in this blog post.

Cataract surgery is a common procedure that involves removing the cloudy lens of the eye and replacing it with an artificial lens. While it is more commonly associated with older adults, children can also develop cataracts, which can significantly impact their vision.

Cataract surgery in children is a delicate procedure that requires the expertise of a skilled paediatric ophthalmologist. In this blog, we will cover everything you need to know about symptoms, causes, procedure, risks, recovery, and more.

Symptoms of childhood cataracts

1. Cloudy or Blurry Vision:

Cataracts cause the lens of the eye to become cloudy, leading to blurry or distorted vision. For children, this might manifest as difficulty focusing on objects, seeing things clearly, or constant complaints about not being able to see well. In severe cases, the world may appear as if the child is looking through a foggy window.

2. Reduced Visual Acuity or Difficulty Seeing in Low Light Conditions:

Children with cataracts often struggle to see clearly, especially in dimly lit environments or at night. Reduced visual acuity can affect their ability to perform daily tasks, such as reading or playing, and they may also have trouble seeing clearly at a distance. This symptom may go unnoticed until parents realise their child is frequently squinting or sitting very close to screens or objects.

3. Abnormal Eye Movements or Nystagmus:

Nystagmus is a condition where the eyes make repetitive, uncontrolled movements, often described as “shaking” of the eyes. In children with cataracts, the brain may struggle to process the visual information clearly, leading to these abnormal eye movements. This can impair the child’s ability to focus on objects and maintain steady vision.

4. Sensitivity to Light or Glare:

Increased sensitivity to bright light, also known as photophobia, is common in children with cataracts. They may experience discomfort when exposed to sunlight or bright indoor lighting. Glare from reflective surfaces, such as water or glass, can also be particularly bothersome, causing children to squint or turn away from light sources.

5. Poor Depth Perception or Difficulty with Spatial awareness:

Cataracts can impact a child’s depth perception, making it difficult for them to judge distances accurately. This may affect their coordination, leading to clumsiness, difficulty walking, or challenges with tasks like climbing stairs or catching a ball. The child may struggle to perceive how far away objects are, causing them to bump into things more often than usual.

6. Strabismus (Crossed or Misaligned eyes):

Strabismus occurs when the eyes are not aligned properly, leading to one eye turning inward, outward, upward, or downward. In children with cataracts, the misalignment may result from the brain trying to compensate for the blurred or obstructed vision in the affected eye. Strabismus can further reduce the child’s ability to see clearly and may cause double vision if left untreated.

7. White or Gray Pupil (Leukocoria):

In some cases, cataracts cause the normally black pupil of the eye to appear white, gray, or milky. This phenomenon, known as leukocoria, is one of the most noticeable signs of cataracts in children. It may become more apparent in certain lighting conditions or when taking photographs, where the reflection in the eye may show an abnormal white spot instead of the typical red-eye reflex.

Causes of cataract in children

There are several possible causes of cataracts in children or infants, including:

1. Congenital cataracts: These are cataracts that are present at birth and may be caused by genetic or developmental factors.
2. Infections during pregnancy: Certain infections that a mother may contract during pregnancy, such as rubella, herpes, or toxoplasmosis, can increase the risk of cataracts in the infant.
   
3. Injuries or trauma: Injuries to the eye or head can sometimes cause cataracts in children.
   
4. Medical / genetic conditions: Certain medical conditions, such as Down syndrome, galactosemia, and Lowe syndrome, are associated with a higher risk of cataracts.
   
5. Medications: Some medications, such as steroids (eye drops, creams or systemic steroids), can increase the risk of cataracts in children.
   
6. Radiation exposure: Exposure to radiation, such as during cancer treatment, can increase the risk of cataracts.
   
7. Unknown: In some cases, the cause of cataracts in children may be unknown.

It is important to note that while some risk factors for cataracts in children can be identified, many cases of childhood cataracts occur without an obvious cause. If your child is diagnosed with a cataract, your ophthalmologist will work with you to determine the most appropriate course of treatment based on the underlying cause, severity of the cataract, and other individual factors.

What Is Cataract Surgery in Children?

Understanding Cataracts

Before we dive into the details of cataract surgery in children, let’s first understand what cataracts are. Cataracts are a clouding of the eye’s natural lens, which is responsible for focusing light onto the retina at the back of the eye. This clouding can cause blurred or cloudy vision, and in some cases, can even lead to blindness. While cataracts are more commonly associated with older adults, children can also develop them for a variety of reasons, including genetic conditions, trauma, or infection.

Cataract Surgery in Children

Cataract surgery in children is a procedure that involves removing the cloudy lens of the eye, and often (but not always) replacing it with an artificial lens. The procedure is typically performed under general anaesthesia and takes around 30-60 minutes. 

During the surgery, the paediatric ophthalmologist will make a small incision in the eye and use specialised instruments to break up and remove the cloudy lens. In all infants and some older children, the vitreous gel may also need to be removed carefully. The surgeon may then insert an artificial lens, which will help to restore the child’s vision.

Intraocular Lens Options

There are a variety of intraocular lens (IOL) options available for children undergoing cataract surgery. The type of lens chosen will depend on the child’s age, prescription, and other factors. Some of the most common types of IOLs used in children include:

• Monofocal IOLs: These lenses provide clear vision at a single distance. These are the most commonly used IOLs in children. 
• Multi-focal IOLs: These lenses provide clear vision at multiple distances and can reduce the need for glasses or contacts. They may be considered in older children. 
• Toric IOLs: These lenses are designed to correct astigmatism, which is a common refractive error that can cause blurred or distorted vision.

What Are the Risks of Cataract Surgery in Children?

Like any surgical procedure, cataract surgery in children does carry some risks. Some of the most common risks associated with the procedure include:

• Infection
• Bleeding
• Inflammation
• Retinal detachment
• Glaucoma (higher risk in younger infants)

It is important to note that while these risks are present, the overall risk of serious complications is relatively low, particularly when the surgery is performed by an experienced ophthalmologist.

What Is the Recovery Process Like?

The recovery process following cataract surgery in children is generally straightforward, but can take four or more weeks. Children will typically be able to go home the same day as the surgery, but they will need to avoid any strenuous activities or contact sports for a few weeks. They may also need to wear an eye patch or shield for a short period of time to protect the eye while it heals.

It is important to follow all post-operative instructions provided by the ophthalmologist to ensure the best possible outcome. This may include using eye drops to reduce inflammation and prevent infection, avoiding swimming or other activities that could introduce bacteria to the eye, and attending follow-up appointments to monitor healing and ensure that the new lens is functioning properly.

Conclusion

Cataract surgery in children is a delicate procedure that can restore vision and improve quality of life for young patients. While it does carry some risks, the overall risk of serious complications is relatively low when the surgery is performed by an experienced ophthalmologist. If you suspect that your child may have a cataract, it is important to seek medical attention as soon as possible to determine the best course of treatment.