(With acknowledgements to the Online Journal of Ophthalmology: www.onjoph.

com)
Opacity in lens

Can be: Visually significant or not
Stable or Progressive
Congenital or Acquired
Unilateral or Bilateral
Partial or Complete

Congenital: incidence 6/10 000
10% of childhood blindness

Systemic diseases : Diabetes mellitus
: Myotonic dystrophy
: Atopic dermatitis
: Neurofibromatosis 2

Ocular diseases : Chronic anterior uveitis
: High myopia
: Fundus dystrophies eg Retinitis
pigmentosa

Drugs : Corticosteroids
: Chlorpromazine

Trauma : Blunt
: Sharp


Genetic Mutation : Autosomal Dominant
Metabolic : Galactosaemia
: Lowe
: Hypoparathyroidism
: Fabry

Infective : TORCH organisms

Chromosomal : Trisomy 21 (Down)
: Trisomy 18 (Edward)
: Trisomy 13 (Patau)

Skeletal : Hallerman-Streiff
: Nance-Horan
Ocular anomalies : Aniridia
: Anterior segment dysgenesis syndrome
Idiopathic : in 50%








Sporadic, no family history

Ocular anomalies : Persistent foetal vasculature

Cause identified in only 10%

Screen newborns with red reflex test
History : Family
Maternal infections
Examination: systemic diseases or syndromes

Workup: Bilateral cases without known hereditary
basis
TORCH screen
s-glucose
s-calcium, phosphate
Urine: reducing substances (galactosaemia)
amino acids ( Lowe syndrome)
haematuria (Alport syndrome)
Formal estimate of vision not possible in neonate
Special tests: Preferential looking test, visually evoked
potentials

Density and position of cataract

Morphology

Associated ocular pathology

Indicators of severe visual impairment : No fixation
Nystagmus
Strabismus
In central visual axis, bigger than 3mm
Posterior cataract
No clear zones in between
Retinal details not visible with direct
ophthalmoscope
Nystagmus or strabismus present
Poor central fixation after 8 weeks

Surgery: Cataract extraction and intraocular lens
implantation for visually significant cataract


By 6 weeks of age


Bilateral cases: 1 week apart


Non visually significant cases : careful observation, possible
pupillary dilation




Intraocular lens : Power of lens Myopic shift of the
growing eye

Surgical technique

Postoperative intraocular inflammation (uveitis)

Glaucoma and retinal detachment may develop

Clear vision for distance and near

Intraocular lens: regular refraction

Spectacles

Contact lenses

Treatment of amblyopia : Occlusion therapy




Correct management essential to prevent permanent
visual loss

Team effort ophthalmologist, paediatrician,
geneticist,family

Early detection within the first month of life is very
important

Knowledge of systemic conditions associated with
cataract