What is Congenital Cataract?

Maybe you might have of it before, but what is congenital cataract? Can you imagine what the most common cause of childhood blindness is? Yeah, it is congenital cataract. Now, do you know that congenital cataract is the most common treatable and preventable cause of childhood blindness?

Here, we will discover what congenital cataract is. And why early diagnosis is so important in preventing its horrible sequelae.

What is congenital cataract?

If your baby is suffering from cataract, this means that the eye’s natural crystalline clear lens is rather opaque and cloudy.

Congenital cataract is a term used to describe lens opacities that are present at birth. Infantile cataract on the other hand, is used to describe lens opacities that develop during the first year of life.

Many physicians use the two terms interchangeably, because some lens opacities escape detection at birth and are discovered later in life.

What is the prevalence of congenital cataract?

Congenital cataract is fairly common. It occurs in 1 of every 2000 live births. Congenital cataract is responsible for about 10% of vision loss that occur during childhood, yet it is the most common preventable and treatable cause of visual impairment and blindness during childhood and infancy.

Do all types of congenital cataract affect vision?

Some types of congenital cataract do not progress and are visually insignificant and don’t require any type of intervention (as in the case of peripheral cataracts that don’t affect the central portion of the lens, or are very small and faint opacities).

Other types of congenital cataract may have a profound visual impairment (as in case of central cataracts, bilateral cataracts, and large deep opacities of the lens).

What are the causes of congenital cataract?

Congenital cataract occurs in newborn babies for many reasons. It may be because of:

  • congenital inherited anomalies
  • maternal infections during pregnancy
  • metabolic disorders
  • diabetes
  • trauma to the eye or to the head
  • inflammatory conditions
  • drug reactions and adverse effects.

Congenital cataract can be classified according to morphological characteristics (size of opacity, site of opacity and degree of opacification), underlying etiology, other associated ocular anomalies, and other associated systemic findings.

Congenital cataract may be unilateral or bilateral. Metabolic disorders tend to be more commonly associated with bilateral cataracts

Approximately one-third of congenital cataracts are a component of a more extensive syndrome or disease (eg, cataract resulting from congenital rubella syndrome), one-third occur as an isolated inherited trait, and one-third result from undetermined causes.

How to discover the presence of congenital cataract?

Early diagnosis of congenital cataract is of supreme importance in preventing its sequelae and complications. That’s why all newborn babies should be routinely screened for the presence of congenital cataract.

This includes: examining the red reflex of the eye, manual retinoscopy to assess the impact of congenital cataract on vision, and laboratory tests like urine and blood tests in cases of congenital cataracts associated with metabolic disorders.

What are the complications and sequelae of congenital cataract?

The presence of congenital cataract can lead to a wide range of complications such as:

–      Blindness due to severe amblyopia (Amblyopia or lazy eye is a condition in which the brain continuously neglects impulses coming from the weaker or the non-seeing eye, and with continuation of this condition, the brain irreversibly doesn’t accept impulses from this eye anymore and this eye becomes a non-seeing eye and therefore, becomes “blind”. This condition can apply to one eye or both eyes as in cases of bilateral congenital cataract).

–      Strabismus or squint (a condition in which the eyes are not properly aligned with each other. This is due to neglection of the brain towards the non-seeing eye).

–      Secondary glaucoma (a condition in which the intra ocular pressure rises leading to damage of the delicate layers of the eye, such as the retina and the optic nerve).

What is the treatment of congenital cataract?

Baby eyesTreatment of congenital cataract varies according to the nature of the lens opacity. Faint small non progressive cataracts or peripheral lens opacities that do not affect vision usually do not need any intervention.

More severe cataracts such as central cataracts (even if they are small in size) and large deep lens opacities usually need surgical removal as early as possible to guard against the development of complications and sequelae.

The timing of cataract surgery in infants is debatable, but most surgeons prefer to postpone the operation until the baby completes three months.

In a nutshell:

So, now that you know what is congenital cataract, you should also know that it is the most common treatable and preventable cause of childhood blindness. Early diagnosis and detection allows for early management and prevention of development of further complications. That’s why your child’s eyes should be examined soon after birth and regularly afterwards during infancy and childhood.

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