Types and Causes of Childhood Cataracts
A cataract is a clouding of the eye’s natural lens. In children, cataracts are classified by when they develop:
- Congenital cataracts— present at birth. The most visually threatening, as the eye’s critical developmental window begins immediately.
- Infantile cataracts— develop within the first year of life.
- Childhood cataracts— develop between ages 1 and 16, often with a more gradual impact on vision.
Causes include genetic mutations (often autosomal dominant), metabolic disorders such as galactosaemia, intrauterine infections (rubella, cytomegalovirus, toxoplasmosis), ocular trauma, and—in many cases—no identifiable cause (idiopathic). A full systemic assessment is important in any child presenting with a cataract.
1–3 / 10,000
Estimated birth prevalence of congenital cataract
Weeks
Window for surgery in dense congenital cataract
Years
Typical duration of amblyopia treatment after surgery
Symptoms Parents Should Watch For
Children rarely report blurred vision—they have no reference point for what clear sight looks like. Parents and carers are the first line of detection. Key warning signs include:
- Leukocoria(white or grey pupil) — the most important sign. Requires urgent referral to rule out cataract and retinoblastoma.
- Nystagmus— involuntary, repetitive eye movements suggesting poor visual input.
- Strabismus(squint) — a misaligned eye that may be suppressed by the brain, leading to amblyopia.
- Head tilting or squinting— a child attempting to find a clearer part of a partially opaque lens.
- Poor visual behaviour— not fixing and following a face by six weeks of age, or apparent vision that is worse than expected for age.
Any white or cloudy pupil is a medical emergency
The Procedure: What Happens During Paediatric Cataract Surgery
Unlike adult cataract surgery—which is performed under local anaesthetic—paediatric cataract surgery is always performed under general anaesthesia. Children cannot cooperate with the awake surgery required in adults.
The cloudy lens is removed through small incisions. IOL (intraocular lens) selection is more complex in children because the eye continues to grow, changing its refractive power over time. Surgeons must target a lens power that accounts for this anticipated growth, typically aiming for a degree of deliberate far-sightedness in young children.
In infants under six months, an IOL is often notimplanted at the primary operation. Instead, a contact lens or glasses provide optical correction until the eye has grown sufficiently—usually from around age two—for a secondary IOL to be considered.
Specific surgical steps also differ from adult surgery: a posterior capsulotomy and anterior vitrectomy are routinely performed at the time of the initial operation in young children, because posterior capsule opacification occurs almost universally and at a much faster rate than in adults.
Surgical risks specific to paediatric cataract
- • Posterior capsule opacification — very common; often needs further management
- • Glaucoma post-operatively — a significant long-term risk requiring monitoring
- • Retinal detachment — rare but increased risk compared to adults
- • Refractive error changes as the eye grows — frequent prescription adjustments needed
Concerned about your child’s vision?
Dr Parth Shah provides specialist paediatric ophthalmology assessments in Canberra, including evaluation of cataracts, strabismus and amblyopia.
Paediatric vs Adult Cataract Surgery
The underlying goal — removing an opaque lens to restore clear vision — is the same in children and adults, but the surgical approach, IOL strategy, and post-operative management differ substantially.
| Paediatric Cataract Surgery | Adult Cataract Surgery | |
|---|---|---|
| Anaesthesia | General anaesthesia — children cannot cooperate with local drops | Local anaesthetic eye drops — no sedation required |
| IOL placement | Infants <6 months often no IOL; older children need carefully selected lens power accounting for eye growth | Standard IOL based on biometry measurements |
| Post-operative amblyopia treatment | Critical — patching the good eye, glasses or contact lens correction often required for months to years | Not required — visual system fully developed |
| Posterior capsule opacification | Very common in children — often needs surgical management or later laser | Less common, usually managed with a simple in-office laser procedure |
| Long-term monitoring | Intensive follow-up for amblyopia, glaucoma, and refractive changes as the eye grows | Routine post-operative review |
Post-operative Care and Amblyopia Treatment
Removing the cataract is only the beginning. The operated eye now has a clear optical path, but the visual cortex has not yet learned to “see” with it. This is where amblyopia treatment becomes critical.
The primary approach is patching the fellow (good) eye for a prescribed number of hours each day. By blocking the stronger eye, the brain is forced to process visual information from the operated eye, stimulating the development of the visual cortex connections that would otherwise never form.
Patching is typically prescribed for months to years, with the duration and intensity guided by the child’s age, the density of the original cataract, and how amblyopia responds to treatment. Glasses or contact lens correction must also be worn consistently, as the optical prescription is what allows the operated eye to form a sharp image during patching sessions.
The most important factor in the outcome of paediatric cataract surgery is how early treatment begins. The brain’s visual cortex is most plastic—most responsive to treatment—in the first few years of life. Even a delay of weeks in the case of a dense congenital cataract can result in permanently reduced vision that cannot be fully recovered.
Frequently Asked Questions
Most children can return to school within one to two weeks of surgery, once the eye has settled and patching or glasses correction has been established. Your surgeon will advise based on your child's individual recovery.
Written by
Dr Parth ShahDr Parth Shah is a subspecialty-trained Canberra ophthalmologist with expertise in cataract surgery, paediatric eye care and strabismus surgery.
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