Why does the lens become cloudy?
The lens is formed in early pregnancy from transparent fibers arranged in layers. Disruption of this process leads to the formation of cloudy areas. In about a third of cases, the cause is hereditary: the cloudiness runs in the family and usually affects both eyes. Another group of causes are intrauterine infections, primarily rubella, as well as cytomegalovirus and toxoplasmosis. Cataracts occur with chromosomal syndromes and metabolic diseases, such as galactosemia, and can also be the result of injury or inflammation inside the eye. Often the cause cannot be determined, especially when one eye is affected.
- Hereditary forms, often bilateral
- Congenital infections, including rubella
- Chromosomal syndromes
- Metabolic diseases, such as galactosemia
- Consequences of injury or inflammation
- Prematurity and related conditions
What does it look like and why is it dangerous?
The most noticeable sign is a change in the color of the pupil: instead of black, it looks white, gray or cloudy, and in photographs with a flash it does not give the usual red glow. A child with dense cataracts does not follow objects, does not recognize the mother’s face from a distance, and may develop pendulum-like eye twitching or squint. When there is clouding in one eye, the behavior remains almost unchanged in appearance, and such cataracts are often detected later, although it is this cataract that quickly leads to deep amblyopia, because the brain simply stops using the worse-seeing eye.
- White or gray pupil
- No red reflex in the photo
- No eye fixation or tracking
- Eye twitching
- Strabismus
- With unilateral damage, there may be almost no external signs
How to identify
In the maternity hospital and during routine examinations, the doctor checks the reflex from the fundus of the eye: normally, the pupil glows an even red color, but when clouded, the reflex is weakened or absent. This is a simple and very important test. Next, the child is examined by an ophthalmologist with pupil dilation, assessing the density, size and location of the clouding, as well as the condition of the posterior segment of the eye. If the fundus is not visible, an ultrasound is performed. Before the operation, the size of the eye is measured to calculate the artificial lens. Additionally, an examination is carried out for congenital infections and metabolic diseases, and in case of bilateral cataracts, a consultation with a geneticist is carried out.
- Checking the red reflex in a newborn
- Examination by an ophthalmologist with pupil dilation
- Ultrasound of the eye in opaque media
- Biometrics for intraocular lens calculation
- Tests for congenital infections
- Examination for metabolic diseases
- Consultation with a geneticist for bilateral forms
Treatment
Minor opacities that do not interfere with vision are observed. If the cataract is dense and covers the center, surgery is required to remove the clouded lens. The timing is critical: with bilateral lesions, intervention is usually planned in the first weeks or months of life, with unilateral lesions even earlier, since competition with the healthy eye accelerates the development of amblyopia. The issue of immediate installation of an artificial lens is decided individually: in the youngest children, the eye is still growing rapidly, so contact lenses or glasses are often used first, and the lens is implanted later. The operation is performed by a pediatric ophthalmic surgeon.
- Observation for minor opacities
- Early surgical removal of dense cataracts
- Individual decision about lens implantation
- Contact lenses or glasses after surgery in infants
- Routine examinations to monitor eye growth
- Treatment of concomitant diseases
Restoring vision after surgery
The operation is only half the battle. After removal of the lens, the eye is deprived of focusing power, so optical correction is required and must be worn constantly. Then begins long-term work on the treatment of amblyopia: patching the better-seeing eye according to the doctor’s scheme, visual exercises, regularly changing glasses as the child grows. It is the family’s perseverance during this period that determines the final vision. The child needs frequent examinations: monitoring intraocular pressure, since after early operations the development of glaucoma is possible, and the condition of the retina.
- Constantly wearing glasses or contact lenses
- Occlusion of a healthy eye according to a doctor’s scheme
- Regular correction of optics as you grow
- Monitoring intraocular pressure
- Monitoring the condition of the retina
- Pleoptic treatment and visual exercises
- Family support and patience - the result does not come immediately
