Congenital cataract: a cloudy lens in a baby's eye, diagnosis and treatment

The lens sits behind the pupil and focuses light onto the back of the eye. In a cataract, the NHS explains, the lens becomes cloudy, which blurs vision and, without treatment, leads to loss of sight. In adults, cataracts usually develop slowly with age. In children they are a different matter: the NHS calls childhood cataracts a rare condition that will affect vision and usually needs treatment.

A congenital cataract is present at birth. The sources used for this page do not give timing windows for surgery, so those decisions rest with the paediatric eye team.

The NHS lists main symptoms in babies and children, and adds that older children may also describe changes themselves.

• One or both eyes looking white or cloudy.

• Difficulty following moving objects with the eyes.

• Difficulty focusing on faces or objects.

• One or both eyes moving quickly from side to side, or appearing to wobble.

• A squint.

• In older children: blurred, cloudy or distorted vision, difficulty seeing in low light, seeing a bright ring or halo around lights, difficulty reading, and bumping into things.

The newborn physical examination looks for problems with a baby's eyes, heart, hips and testicles, and the NHS names childhood cataracts among the conditions it checks for. It is normally done within 72 hours of birth and offered again by the GP when the baby is 6 to 8 weeks old, because some of the things it looks for can take longer to develop. The examiner looks at the baby's eyes with a special torch to check how they focus and move. It is not painful and there are no known risks.

If the examination finds something, the NHS says the healthcare professional will explain what this might mean and what happens next, and the baby is referred to a specialist for tests and treatment if needed.

If you think your child has cataracts, the NHS advises contacting your GP. A GP can check their eyes and refer them to an eye specialist (ophthalmologist) if needed. If you notice a white or cloudy eye, or your baby does not seem to follow faces or objects, contact your GP rather than waiting.

The NHS says it is not known what causes childhood cataracts. It lists situations in which a child may be more likely to have them.

To check for childhood cataracts, the NHS says an eye doctor (ophthalmologist) uses eye drops to increase the size of the child's pupils and looks into the eyes with a light. Congenital cataracts are also checked for at birth as part of the newborn physical exam.

The specialist team will decide how much the cataract affects vision, and whether it is in one eye or both. The NHS does not describe further tests, so your own eye team is the best source on any additional assessments your child needs.

The NHS says the main treatment is an operation to remove the cloudy lens, which helps improve vision and prevents the child losing their sight. The child is given a general anaesthetic, so they are asleep and do not feel anything, and the surgery usually takes around an hour.

During surgery the surgeon makes a small cut in the surface of the eye (the cornea) and removes the cloudy lens. In older children an artificial lens is placed into the eye and stitched into place, and the stitches dissolve on their own. Babies may not be given an artificial lens during the operation; the NHS says they will usually be given contact lenses or glasses until they are older, when they can have an artificial lens fitted. If a child has a cataract in both eyes, they may have two separate operations to give time to recover.

The NHS says a child may still need glasses after surgery to see clearly, and that vision may be blurred at first but should improve as the eye heals.

After the operation, the NHS says babies may need to stay in hospital overnight and older children will usually go home the same day. For the first few weeks, the child will need eye drops, which the hospital team shows you how to give. The drops help the eye heal and reduce the risk of infection and swelling. An eye shield may be given to wear over the eye at night.

If the eye becomes crusty or sticky, the NHS advises gently cleaning it using cooled boiled water and a clean tissue, without rubbing or pressing on the eye. Paracetamol can be given for pain. The hospital team will say when your child can return to school or nursery.

Newborn eye checks, referral to a paediatric ophthalmology service and cataract surgery in children are all provided as part of NHS care. Because children's cataract surgery and the follow-up with glasses or contact lenses is specialised, it is usually done in centres that treat children's eye conditions regularly. A second opinion can be sought privately, but keep your NHS team in the loop so that vision monitoring continues without gaps.