The sooner cataracts are found, the better; many are picked up by newborn screening programs – before your baby is discharged from hospital he or she has been checked by a paediatrician who looked in his or her eyes with an ophthalmoscope.
Others are found later after the child shows some of the symptoms below. If any of these symptoms are found, your child should be examined by a pediatric ophthalmologist (an eye consultant who specialises in children).
It’s almost certainly not worth specially looking for symptoms of cataracts in your child; they are rare. If you have a reason to believe they might be there, perhaps because you or another family member has had childhood cataracts, you should mention it when your child is screened as a newborn and get a referral to a pediatric ophthalmologist if you’re concerned.
Cataracts are not the most common reason for any of the symptoms listed below, other than a white pupil, but any of them can be signs of other eye problems and should be properly investigated. Because it is often very important to get cataracts and other eye problems in children treated quickly, don’t delay in getting an appointment or wait and see if it gets better if you are worried about anything.
1. A white pupil- Leukocoria
(Leukocoria is pronounced Lew-ko-cor-ee-a, not to be confused with Leucorrhoea, pronounced Lew-cor-ee-a which is gynaecological). A few cataracts are quite obvious to parents, usually where they are towards the front of the lens and the pupil appears white or to have cloudy spots in it. When, as in most cases, the cataract is further back in the lens, the eye may look normal.
2. Missing, or uneven red reflex
When you look at a flash photograph of your child with ‘red-eye’ the two eyes should reflect back the same colour which could be golden, orange or red. If one eye reflects white, or both do or they reflect different colours it is a sign that your child should be examined promptly as it may be a sign of a number of ocular problems including cataract, but also including a squint developing, coloboma, retinal detachment or retinoblastoma. Take the photos (and some ‘before’ photos if you have them) to show the doctor as it can help to work out how long the problem’s been going on
3. Squint (Strabismus)
A squint is when the eyes point in different directions. If a child has had a cataract for a while, his or her brain may start to switch off from getting visual information from that eye. When this happens, the brain may then stop sending signals to the eye muscles to control the direction the eye is looking and it may drift away from the other eye. Sometimes the first parents may know about a cataract is when their child is being investigated for a squint, although this is unusual. Squint is a very common childhood problem (5-8% of all children) and most squints are NOT caused by cataracts.
Squints can also be easier to spot in photos. If the light that catches the surface of the eye seems to be in a slightly different place on each of the eyes, this can be a sign that the eyes are not pointing in exactly the same direction. Again, take the photo with you to show the doctor and have a look at some older ones to see if you can spot when the squint might have started. Photos may also be a good way to capture a squint that is only happening sometimes, perhaps when your child is tired.
A squint is the only symptom here that may not need an appointment with a specialist quite so quickly. If a GP or optometrist (optician) has had a look in the eyes and can’t see anything that might be causing the squint it is very unlikely to be caused by cataract or anything else that would need very quick treatment, so it’s reasonable to expect to wait a little while for an appointment, although squints are easier to treat if they’re caught early.
4. Problems seeing
Some parents notice that their child doesn’t seem to be looking at them, or ‘fixing and following’ things with their eyes. By about twelve weeks, your child should be doing this and if not it can be a sign of a problem.
It’s often not obvious that a young child has a problem seeing; they may appear to be doing fine, even when they have quite limited vision, so don’t assume that your child has no vision problem just because they appear to be doing OK.
Other children are often much better at noticing when a child is having problems seeing than parents or other adults are, so do pay attention to any comments other children make.
5. Light sensitivity
If light seems to hurt your child’s eyes, or they are screwing up their eyes outdoors or in bright light this can be a sign of cataracts and a number of other eye problems.
6. Wobbly eyes (Nystagmus)
All eyes move slightly as we look at something, but so little that we don’t notice it. When a child’s eyes look as though they are wobbling, it is a sign that they are having problems seeing, or of other problems that need to be looked into.
7. Damage to the eye
This can happen sometimes because of surgery for other eye conditions or if your child has an accident.
Checked for medical accuracy by Miss Isabelle Russell-Eggitt, Consultant Paediatric Ophthalmologist, Great Ormond Street Hospital, London