By David Mallory, M.D.

    One out of every 250 newborns has some form of a cataract. It has been estimated that 15 to 20 percent of all blindness in children is caused by cataracts. One study of American 10 year-olds showed cataracts to be the most common cause of blindness.

    One-fourth of congenital cataracts (cataracts present at birth) are inherited. Rubella or German measles during the first three months of pregnancy can cause cataracts and is the leading cause of preventable blindness in children in some countries. Certain medications taken during pregnancy, such as steroids and some antibiotics, can cause cataracts in the newborn.

    Although rare, a cataract may develop in an infant as a result of an enzyme deficiency. Galactosemia develops because the body lacks a certain enzyme necessary to metabolize galactose in milk. If the infant is taken off milk and milk products before the fourth week of life, the cataract can actually disappear. This is the only type of cataract that can reverse itself and go away without surgery.

    One of the most common causes of cataracts in children is an injury to the eye. If the lens of the eye is penetrated or ruptured, a cataract may develop within hours. A lesser blunt injury may result in a cataract years later.

    Most adults who have cataracts will seek eye care because of blurred vision. An infant or child, however, especially if the cataract is in only one eye, will have no complaints and may look and act perfectly normal. This can result in a long delay in diagnosis. A white pupil may be the reason parents seek treatment. In this case the cataract is very advanced or mature, allowing little light to enter the eye. The most common malignant tumor of the eye, called retinoblastoma, may also present a white pupil and mimic a cataract. It may be noticed at birth or not until three years of age. Immediate treatment to save the child's life and vision is extremely important.

    A child with a cataract in one eye may have a "crossed" eye. If the cataracts are in both eyes and are very dense, an infant will develop a jerky, wandering of the eyes called nystagmus by three months of age. Some cataracts in children may be present with light sensitivity as the problem, or the parents may notice only a general inattention to the environment.

    Phacoemulsification, or the ultrasonic removal of cataracts and the refinement of intraocular lens implants, have revolutionized the treatment of cataracts in children. Because an infant can develop amblyopia (a lazy eye) within days if a dense cataract is present, early diagnosis and treatment are vital.

David Mallory M.D. is a cataract, intraocular lens, and laser surgery specialist in practice at the Southwest Eye Clinic.

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