CATARACTS

INTRODUCTION

⦁ A cataract is the opacity of the lens or cloudiness.

⦁ This may be present at birth, or it may become apparent in early childhood.
⦁ A dominantly inherited condition, whereas in others, it may be a result of another
disease process such as GALACTOSEMIA or SCARRING FROM AN INJURY.
⦁ GALACTOSEMIA: congenital disorder caused by a deficiency of different
enzymes in the metabolism of galactose (one of the monosaccharides)
⦁ A few children develop cataracts as a result of steroid use (Prolonged
prednisone) or radiation exposure (damage to the lens cell membrane).
⦁ If the opacity is located at the ANTERIOR SURFACE OF THE LENS, then the
cause is thought to be a BIRTH INJURY or possible contact between the lens and the
cornea during intrauterine life.
⦁ If the opacity is located AT THE EDGE OF THE LENS, it may be a result of
NUTRITIONAL DEFICIENCY during intrauterine life, such as Hypocalcemia
⦁ A quarter of infants born to women who were exposed to or contracted rubella
may develop cataracts.
 RISK FACTORS
⦁ Age

⦁ Associated ocular conditions:

a. Myopia (Also known as Nearsightedness) (common vision condition in
which near objects appear clear, but objects farther away look blurry)
b. Retinal Detachment (retina is pulled away from its normal position)
c. Infection

⦁ Toxic Factors:
a. Ionizing Radiation
b. Aspirin
c. Corticosteroids (Glucocorticoids)
d. Cigarette Smoking
e. Chemical burns (because is can penetrate into the anterior chamber
causing cataract formation, damage to the ciliary body and damage to the
trabecular meshwork)
⦁ Nutritional Factors:
a. Poor nutrition

⦁ Physical Factors:
a. Blunt trauma (from an accident or a violent attack)
b. Ultraviolet radiations in sunlight and X-Ray

⦁ Systemic Disease and Syndromes:

a. Diabetes (because high blood sugar (glucose) level can lead to structural
changes in the lens of the eye that can accelerate the development of cataracts)
b. Renal Disorders (due to hypocalcemia, oxidative stress, or increased
circulating urea)
c. Musculoskeletal Disorders (overexertion)

TYPES OF CATARACTS

1. CONGENITAL CATARACT
⦁ 33% of its cases are idiopathic
⦁ Hereditary causes:
a. Chromosomal Disorder (Trisomy 21)
 b. Stickler Syndrome (a connective tissue disorder that can include ocular
findings of myopia, cataract, and retinal detachment
c. Lowe's Syndrome (condition that primarily affect the eyes, brain, adn
kidneys, exclusive in males)
⦁ Maternal Factors (DIRM):
a. Drugs like corticosteroids
b. Infections such as rubella
c. Radiation
d. Malnutrition etc. may lead to cataract
⦁ Fetal Factors:
a. Oxygen deficiency
b. Birth trauma
c. Malnutrition and sometimes may be associated with other congenital
factors

2. ACQUIRED CATARACT
SENILE CATARACT
⦁ A common eye condition characterized by the clouding and thickening of the
natural lens in the eye, leading to decreased vision.
 TYPES OF SENILE CATARACT

1. CORTICAL SENILE CATARACT

⦁ characterized by white, wedge-like opacities that start in the periphery of
the lens and work their way to the center in a spoke-like fashion
⦁ progress very slowly and often do not cause severe loss of vision
⦁ Sunlight exposure is a risk factor of cortical cataracts

2. NUCLEAR SENILE CATARACT

⦁ A result of progressive yellowing and hardening of the central lens
(nucleus)

3. POSTERIOR SUBCAPSULAR CATARACT

⦁ A cloudy area at the back of the lens and cause visual loss
⦁ Typically develops in younger people and is associated with prolonged
corticosteroid use, diabetes, or ocular trauma.
ASSESSMENT OF CATARACTS:

⦁ Inspect the pupil of a child with a cataract, the red reflex elicited by shining
a light into the pupil appears white.
⦁ Older children may report blurred vision, because of cataract formation. In
the infant, this can be detected by lack of response to a smile or an inability to
reach and grasp a nearby object.
⦁ The infant may also demonstrate nystagmus from being unable to focus
the eye on objects.
⦁ A few other conditions, such as retinoblastoma, retinopathy of prematurity,
congenital glaucoma, or an abscess of the posterior chamber, stimulate this
appearance.

DIAGNOSTIC TESTS:
⦁ Snellen Visual Acuity Test
⦁ Ophthalmoscopy (Ophthalmoscopy is an examination of the back part of
the eye (fundus), which includes the retina, optic disc, choroid, and blood
vessels.)
⦁ Slit Lamp Examination (Slit Lamp is a special microscope with a bright
light attached to it that your eye care specialist will use to look at the different
parts of your eyes including the cornea, iris, vitreous, and retina)

MANAGEMENT:
⦁ Treatment of childhood cataract is the surgical removal of the cloudy lens,
followed by insertion of an internal ocular lens.
⦁ If the total lens is involved, this may be done as early as 3 months of age.
If this is not done before 6 years of age, amblyopia may result.
⦁ Introduce fluids cautiously after eye surgery so nausea and vomiting do
not occur because vomiting increases intraocular pressure (IOP) (fluid pressure
of the eye), which could injure the suture line.
⦁ Encourage parents to stay with their infant and to help with care so the
infant does not cry because crying also increases IOP.