Cataracts

Key Features

• May be unilateral or bilateral

• May exist as isolated defects

• May be accompanied by other ocular disorders or systemic disease

Clinical Findings

• Leukocoria, poor fixation, and strabismus or nystagmus may be the presenting complaints

• Absence of a red reflex in the newborn may be due to a cataract, which requires an urgent referral to an ophthalmologist

Diagnosis

• Laboratory investigation for infectious, genetic and metabolic causes of bilateral congenital cataracts is often indicated

• Such investigation would include cultures or serologic tests for

  • Toxoplasmosis

  • Rubella

  • Cytomegalovirus

  • Herpes simplex virus

  • Syphilis

  • Inborn metabolic errors, such as galactosemia or Lowe syndrome

Treatment

• Early diagnosis and treatment are necessary to prevent deprivation amblyopia in children younger than 9 years because they are visually immature

• Cataracts that are visually significant require removal

• Visually significant cataracts in infants are usually removed prior to 6 weeks of age to prevent deprivation amblyopia

• Rehabilitation of the vision will require the correction of refractive errors and amblyopia treatment

• Contact lenses, glasses, and artificial intraocular lenses are used to correct refractive errors after cataract extraction

• Concomitant treatment of associated amblyopia, glaucoma, and the underlying systemic disease as indicated