Can Young People Develop Cataracts? Causes, Warning Signs and Treatment

Author: Dr Val Phua
Estimated reading time: 18 minutes

Yes. Cataracts can occur at any age.

Although most cataracts develop gradually as the natural lens ages, a baby may be born with a cataract, a child may develop one during visual development, and a teenager or young adult may develop a cataract because of trauma, inflammation, medication, diabetes or another medical condition.

Cataracts in younger people may be classified as:

• Congenital cataracts: present at birth
• Infantile cataracts: detected during the first year of life
• Developmental or childhood cataracts: develop or become apparent later in childhood
• Juvenile cataracts: occur during childhood or adolescence
• Early-onset cataracts: develop in younger adults earlier than expected for ordinary age-related cataract

Children can develop cataracts because of genetic conditions, problems occurring during pregnancy, childhood illness, eye inflammation, injury, radiation or corticosteroid exposure. Some cataracts remain small and do not affect vision, while others require urgent treatment to prevent permanent visual impairment.

The central message is:

Cataracts are not limited to older adults. In babies and young children, a visually significant cataract may be time-sensitive because it can prevent normal development of the brain’s visual pathways.

What Is a Cataract?

A cataract is clouding or optical irregularity within the eye’s natural crystalline lens.

The natural lens is located behind the coloured iris. It should normally be transparent so that light can pass through and focus clearly on the retina.

A cataract may cause:

• Blurred or hazy vision
• Glare
• Halos
• Poor contrast
• Faded colours
• Double or ghosted images from one eye
• Increasing short-sightedness
• Difficulty seeing in dim lighting

In an infant or young child, the problem is more than blurred vision. A dense cataract can block the clear visual image that the developing brain requires to learn how to see.

Are Cataracts in Young People Common?

Cataracts in children are much less common than age-related cataracts, but they remain an important cause of preventable lifelong visual impairment.

The consequences depend on:

• The child’s age
• Whether one or both eyes are affected
• Cataract density
• Cataract location
• How long the visual axis has been obstructed
• Whether treatment and optical correction begin promptly
• Whether amblyopia treatment is followed consistently

Young-adult cataracts are also less common than cataracts in older adults. When a cataract develops unusually early, the ophthalmologist may investigate whether there is an identifiable ocular, medical, medication-related or genetic cause.

What Is a Congenital Cataract?

A congenital cataract is present at birth, even if it is only detected later.

“Congenital” does not necessarily mean inherited.

A congenital cataract may result from:

• A genetic variant
• A chromosomal or systemic condition
• An infection or other problem during pregnancy
• Abnormal development of the eye
• A metabolic disorder
• An unknown cause

Some congenital cataracts are visible immediately. Others are small, peripheral or incomplete and may only be discovered during routine screening or when the child begins showing abnormal visual behaviour.

What Is a Developmental Cataract?

A developmental cataract is not necessarily obvious at birth.

It may:

• Develop later during childhood
• Become denser as the child grows
• Be discovered when vision testing becomes possible
• Be associated with an inherited cataract pattern
• Occur after inflammation, trauma or medication exposure

Some inherited cataracts are progressive. A child may have relatively useful vision initially but develop increasing glare, blur or short-sightedness over time.

Why Are Cataracts More Urgent in Babies?

A baby is not born with fully developed adult vision.

The eyes and brain must receive clear, well-focused and approximately balanced images during a critical period of visual development.

When a dense cataract blocks vision:

• The retina receives a poor image
• The visual pathways are not stimulated normally
• The brain may suppress the affected eye
• Amblyopia develops
• Permanent visual limitation may remain even after the cataract is removed

This is called deprivation amblyopia.

Congenital and infantile cataracts are therefore different from ordinary adult cataracts. An older adult may safely monitor a cataract until it interferes with daily life, whereas a dense central cataract in an infant may require treatment during early visual development.

Does Every Childhood Cataract Require Surgery?

No.

A cataract may be monitored when it is:

• Small
• Peripheral
• Outside the visual axis
• Not causing significant blur
• Not causing strabismus or nystagmus
• Not interfering with visual development
• Stable on follow-up

Some partial cataracts may be managed with:

• Spectacles
• Contact lenses
• Pupil-modifying medication in selected cases
• Amblyopia treatment
• Regular visual and lens assessment

Surgery is more likely to be recommended when the cataract is:

• Dense
• Central
• Large enough to obstruct the visual axis
• Associated with reduced visual behaviour
• Causing significant unequal vision
• Producing strabismus or nystagmus
• Progressively worsening
• Interfering with school, driving or daily activities

The decision is based on visual significance rather than the mere presence of a lens opacity.

What Causes Cataracts in Babies and Children?

There are many possible causes.

Sometimes a full evaluation identifies a cause. In other children, particularly those with a cataract in only one otherwise normal eye, no specific cause is found.

Genetic and Inherited Cataracts

Genetic causes are important, particularly when cataracts affect both eyes.

A cataract may be inherited in an:

• Autosomal dominant pattern
• Autosomal recessive pattern
• X-linked pattern
• Mitochondrial pattern

The cataract may occur alone or as part of a broader syndrome involving:

• Hearing
• Development
• Muscles
• Kidneys
• Skin
• Skeleton
• Metabolism
• Retina
• Other organs

A family history may include relatives who:

• Had childhood cataract surgery
• Were born with poor vision
• Developed cataracts unusually early
• Had unexplained visual impairment

However, the absence of a family history does not exclude a genetic cause. A new genetic variant may arise in the child, or relatives may have had cataracts too mild to be recognised.

Is Every Congenital Cataract Hereditary?

No.

Congenital means present at birth.

Hereditary means passed genetically through a family.

A congenital cataract may be:

• Hereditary
• Caused by a new genetic variant
• Related to an infection or exposure during pregnancy
• Associated with abnormal eye development
• Metabolic
• Unexplained

The terms should not be used interchangeably.

Infections During Pregnancy

Certain maternal infections during pregnancy may interfere with fetal eye development.

Examples traditionally associated with congenital cataract include:

• Rubella
• Cytomegalovirus
• Toxoplasmosis
• Varicella
• Herpes infections

The baby may have cataracts together with other findings involving:

• Hearing
• Heart
• Brain
• Growth
• Retina
• Liver
• Other organs

Not every maternal infection causes a cataract, and not every congenital cataract is caused by infection. The child’s paediatrician may recommend systemic or laboratory investigation when the clinical pattern suggests an antenatal infection.

Metabolic Conditions

Some metabolic disorders can cause cataracts in infancy or childhood.

Possible examples include disorders involving:

• Galactose metabolism
• Calcium or phosphate balance
• Copper metabolism
• Amino acids
• Peroxisomal or mitochondrial function

A rapidly developing bilateral cataract in a young person may occasionally be the first visible clue to an underlying systemic condition.

Cataract associated with metabolic disease may occur together with:

• Poor growth
• Developmental concerns
• Muscle symptoms
• Neurological symptoms
• Kidney abnormalities
• Abnormal blood tests

Young-adult cataracts have been described with conditions such as chronic hypocalcaemia and hypoparathyroidism, although these are uncommon causes.

Chromosomal and Systemic Syndromes

Cataracts may occur as part of a multisystem or chromosomal condition.

Examples may include selected cases involving:

• Down syndrome
• Myotonic dystrophy
• Marfan-related or connective-tissue conditions
• Lowe syndrome
• Neurocutaneous conditions
• Other rare syndromes

The cataract’s appearance may sometimes suggest a particular diagnosis, but genetic or systemic evaluation is often required.

Abnormal Eye Development

A congenital cataract may accompany other abnormalities within the same eye, including:

• Microphthalmia
• Persistent fetal vasculature
• Coloboma
• Aniridia
• Anterior-segment dysgenesis
• Retinal abnormalities
• Optic nerve abnormalities

These associated conditions may affect:

• Surgical complexity
• Artificial-lens placement
• Glaucoma risk
• Visual potential
• Long-term follow-up

An apparently simple white pupil therefore requires a complete examination of the entire eye rather than an assumption that cataract is the only problem.

Eye Trauma

Trauma is an important cause of cataract in children, teenagers and young adults.

A traumatic cataract may follow:

• A ball hitting the eye
• A racquet, finger or toy injury
• A fall
• A motor-vehicle accident
• A penetrating object
• Fireworks
• Air-gun or projectile injury
• Electrical injury
• Previous unnoticed childhood trauma

Both blunt and penetrating injuries can damage the lens.

A blunt impact may produce a characteristic rosette-shaped cataract. Penetrating trauma may tear the lens capsule and cause rapid lens clouding. Trauma is reported as a substantial contributor to paediatric cataract, particularly when only one eye is affected.

Can a Traumatic Cataract Appear Years Later?

Yes.

A cataract may develop:

• Immediately after injury
• Over several days
• Over months
• Years later

The original injury may also have damaged:

• The cornea
• Iris
• Lens-supporting zonules
• Retina
• Optic nerve
• Drainage angle

Traumatic cataract surgery may therefore be more complex than ordinary cataract surgery.

Uveitis and Eye Inflammation

Uveitis is inflammation inside the eye.

It may cause cataract through:

• Direct inflammatory damage to the lens
• Changes in the fluid surrounding the lens
• Adhesions between the iris and lens
• Long-term steroid treatment
• Repeated inflammatory episodes

Children with juvenile idiopathic arthritis-associated uveitis may have significant inflammation without obvious pain or redness. Regular screening may therefore be required even when the child has no complaints.

Cataract surgery in an eye with uveitis is usually planned after inflammation has been adequately controlled because active inflammation increases the risk of postoperative complications.

Corticosteroid Medication

Corticosteroids are valuable medicines used for conditions such as:

• Asthma
• Eczema
• Allergy
• Autoimmune disease
• Inflammatory eye disease
• Arthritis
• Neurological disorders
• Organ transplantation

Prolonged or substantial steroid exposure may increase the risk of posterior subcapsular cataract.

Relevant forms include:

• Oral steroids
• Inhaled steroids
• Injected steroids
• Steroid eyedrops
• Potent topical preparations used around the eyes

Risk depends on:

• Dose
• Duration
• Route
• Underlying illness
• Individual susceptibility

Steroid medication should not be stopped suddenly or without guidance from the prescribing doctor. The medical benefit may be essential, and the cataract risk must be balanced against the condition being treated.

Atopy and Severe Allergic Disease

Young people with severe atopic dermatitis may develop cataracts earlier than expected.

Possible contributing factors include:

• Atopic disease itself
• Steroid treatment
• Chronic eye rubbing
• Ocular-surface inflammation

A study of early-onset cataracts in younger adults identified atopy, high myopia, corticosteroid exposure and diabetes among associated factors. Posterior subcapsular cataract was common in that study population.

Diabetes

Diabetes can accelerate cataract formation.

Young patients with poorly controlled diabetes may develop:

• Posterior subcapsular cataract
• Cortical cataract
• Rapid bilateral lens changes
• A snowflake-like cataract pattern in some younger individuals

High glucose may affect the lens through:

• Osmotic stress
• Sorbitol accumulation
• Oxidative injury
• Protein glycation
• Altered lens metabolism

Blur in a young person with diabetes is not always caused by cataract. Rapid changes in blood glucose may temporarily alter refraction, and diabetic retinal disease may also reduce vision.

The assessment may therefore include:

• Refraction
• Slit-lamp examination
• Dilated retinal examination
• Macular OCT
• Review of diabetic control

High Myopia

High myopia is associated with earlier cataract development in some patients.

A young highly myopic patient may develop:

• Nuclear lens changes
• Posterior subcapsular cataract
• Increasing myopia
• Glare
• Reduced contrast

High myopia also carries separate risks involving the retina and macula. Removing the cataract can improve lens-related blur but cannot eliminate the underlying retinal risks of the elongated myopic eye.

Previous Eye Surgery

Cataract may develop after intraocular surgery, including:

• Vitrectomy
• Retinal detachment surgery
• Glaucoma surgery
• Surgery for congenital eye abnormalities

Vitrectomy can accelerate nuclear cataract development, particularly in older teenagers and adults whose natural lenses remain in place.

The cataract may be related to:

• Altered oxygen exposure
• Inflammation
• Medication
• Surgical manipulation
• Pre-existing susceptibility

Radiation Exposure

Radiation may damage the lens and cause cataract.

Relevant exposure may include:

• Radiation therapy near the head or eye
• Occupational ionising radiation
• Accidental radiation exposure
• Certain interventional medical procedures
• Extensive ultraviolet exposure over time

The cataract may develop months or years after exposure. Radiation-related cataract risk depends on dose, location, protection and individual susceptibility.

Can a Young Person Develop a Cataract Without an Identifiable Cause?

Yes.

After appropriate investigation, some cataracts remain idiopathic, meaning that no clear cause is identified.

This is particularly possible when:

• Only one eye is affected
• The rest of the eye is normal
• There is no family history
• There was no remembered trauma
• Systemic examination is normal
• The cataract pattern is non-specific

“Idiopathic” does not mean the cataract is imaginary or untreatable. It means that current evaluation has not identified a specific cause.

What Symptoms Do Cataracts Cause in Young Adults?

A teenager or young adult may report symptoms similar to those experienced by an older adult:

• Gradually blurred vision
• Cloudy or hazy vision
• Increasing glare
• Halos around lights
• Difficulty driving at night
• Faded colours
• Reduced contrast
• Frequent spectacle changes
• Increasing short-sightedness
• Ghosting or double vision from one eye
• One eye becoming worse than the other

A posterior subcapsular cataract can cause severe glare or reading difficulty despite being relatively small because it lies near the central visual axis.

What Signs May Parents Notice in a Baby?

Babies cannot report that their vision is blurred.

Possible warning signs include:

• A white or grey pupil
• An abnormal or absent red reflex
• One pupil looking different in flash photographs
• Poor eye contact
• Failure to follow faces or toys
• Wandering or misaligned eyes
• Rapid involuntary eye movements
• Sensitivity to bright light
• One eye repeatedly turning in or out
• The child appearing to rely on one eye
• Delayed visual behaviour

A child may also show no obvious external sign, which is why newborn and childhood eye screening are important.

What Is a White Pupil?

A white pupillary reflection is called leukocoria.

It may be seen:

• Directly by a parent
• During a red-reflex examination
• Repeatedly in flash photographs
• More clearly in one eye

A congenital cataract can cause leukocoria, but a white pupil has several other possible causes, including retinal disorders and retinoblastoma.

Because some causes are both sight-threatening and life-threatening, persistent leukocoria requires prompt ophthalmic assessment rather than observation at home.

Does One White Reflection in a Photograph Prove Disease?

Not necessarily.

Camera angle, flash position and surface reflection may occasionally create an apparent white reflex.

Concern increases when:

• The same eye repeatedly appears white
• The reflex fills most of the pupil
• The eyes appear different in several photographs
• Strabismus or poor vision is present
• The pupil appears white without photography

Repeated asymmetry should be examined promptly.

What Is an Abnormal Red Reflex?

When light is directed through a healthy clear visual pathway, a reddish-orange reflection is normally seen from the pupil.

The reflex may appear:

• Dull
• Unequal
• Interrupted
• White
• Absent

when there is an opacity or abnormality involving the:

• Cornea
• Natural lens
• Vitreous
• Retina

Red-reflex screening can identify cataracts and other important childhood eye disorders before the child can describe symptoms.

Can Cataracts Cause Strabismus?

Yes.

If one eye provides a blurred image, the brain may stop using it normally.

The poorly seeing eye may then turn:

• Inwards
• Outwards
• Upwards
• Downwards

Strabismus may be the first visible sign of a unilateral cataract.

Early-onset strabismus can further interfere with binocular vision and depth perception.

Can Cataracts Cause Nystagmus?

Dense bilateral cataracts present during early visual development may cause sensory nystagmus.

Nystagmus is an involuntary repetitive movement of the eyes.

Its development may indicate that both eyes have lacked sufficiently clear visual stimulation. Even after cataract surgery, the nystagmus may not disappear completely because the visual pathways developed under blurred conditions.

Can a Child With Cataracts Still Appear to See?

Yes.

A child may:

• Use the better eye
• Look around large objects
• Navigate familiar environments
• See bright lights
• Adapt to gradually worsening vision
• Hold objects unusually close

This can give the impression that vision is normal.

One eye should be assessed independently because the stronger eye may mask severe vision loss in the weaker eye.

How Are Cataracts Diagnosed in Babies and Children?

The examination is adapted to the child’s age and cooperation.

It may include:

• Visual-behaviour assessment
• Age-appropriate visual-acuity testing
• Red-reflex examination
• Pupil examination
• Eye-alignment assessment
• Cycloplegic refraction
• Slit-lamp examination
• Dilated retinal examination
• Eye-pressure measurement
• Ocular imaging
• Examination under anaesthesia when necessary

Visual Assessment

Depending on age, the ophthalmologist may assess whether the child can:

• Fix on a light
• Follow a moving target
• Recognise pictures
• Match symbols
• Read letters
• Use both eyes together

The doctor also compares the visual behaviour of the two eyes.

Cycloplegic Refraction

Cycloplegic drops temporarily relax focusing and dilate the pupil.

This allows measurement of:

• Myopia
• Hyperopia
• Astigmatism
• Unequal prescription between the eyes
• The optical correction required after surgery

Slit-Lamp Examination

The natural lens is examined for:

• Cataract size
• Cataract density
• Cataract location
• Lens-capsule abnormalities
• Associated inflammation
• Evidence of trauma
• Lens instability
• Abnormal eye development

Dilated Retinal Examination

The ophthalmologist examines the:

• Retina
• Macula
• Optic nerve
• Vitreous
• Peripheral retina

When the cataract is too dense to see through, ultrasound imaging may be required to assess the structures behind the lens.

Does Every Child Need Blood Tests or Genetic Testing?

No.

The investigation depends on the pattern.

Further evaluation is more likely when there are:

• Cataracts in both eyes
• A family history
• Developmental concerns
• Dysmorphic or systemic features
• Poor growth
• Hearing loss
• Metabolic symptoms
• Suspected antenatal infection
• An unusual cataract appearance
• No obvious acquired cause

Possible investigations include:

• Paediatric assessment
• Blood and urine testing
• Infection testing
• Metabolic testing
• Genetic counselling
• Targeted gene panels
• Broader genomic testing

A unilateral cataract in an otherwise healthy child is often less likely to have a systemic cause than bilateral cataracts, although associated eye abnormalities still need to be excluded.

When Should Surgery Be Performed?

The ideal timing depends on:

• Age at onset
• Whether one or both eyes are affected
• Cataract density
• Visual-axis obstruction
• Associated ocular abnormalities
• Anaesthetic considerations
• Risk of amblyopia
• Risk of postoperative complications

Dense congenital cataracts generally require early specialist management because prolonged visual deprivation worsens the chance of useful vision.

Studies support better visual outcomes when visually significant congenital cataracts are removed during the critical period of visual development. However, very early surgery also carries higher risks, including glaucoma and visual-axis opacification. Timing must therefore be individualised rather than reduced to one universal age rule.

Is a Unilateral Cataract More Urgent?

A dense cataract affecting only one eye can cause profound amblyopia because the brain strongly favours the clearer eye.

Early management generally includes:

• Cataract removal when indicated
• Immediate optical correction
• Amblyopia treatment
• Close follow-up

Even with technically successful surgery, vision may remain limited when treatment begins after a prolonged period of monocular visual deprivation.

Are Bilateral Cataracts Different?

When both eyes are similarly affected, the brain does not have one perfectly clear eye to favour.

Bilateral cataracts can still cause severe visual impairment and nystagmus, but visual outcomes are often better than in dense unilateral congenital cataract when both eyes are treated appropriately.

The two eyes are usually operated on separately, often within a relatively short interval determined by the surgical team.

How Is Cataract Surgery in Children Different From Adult Surgery?

The principle is similar: the cloudy natural lens is removed.

However, a child’s eye is:

• Smaller
• Softer
• Still growing
• More prone to inflammation
• More likely to develop visual-axis opacification
• Undergoing major refractive change
• At risk of amblyopia

Paediatric cataract surgery may include:

1. Small corneal incisions
2. Opening of the front lens capsule
3. Removal of the lens material
4. Management of the back lens capsule
5. Limited anterior vitrectomy in younger children
6. Implantation of an artificial lens in selected cases
7. Closure of the incisions, often with sutures

The posterior capsule and anterior vitreous are frequently managed during primary surgery in younger children because leaving the capsule intact carries a high risk of rapid visual-axis clouding.

Is an Artificial Lens Always Implanted?

No.

After cataract removal, the eye has lost much of its natural focusing power. This condition is called aphakia when no artificial lens is implanted.

Optical correction may be provided using:

• A contact lens
• Aphakic spectacles
• A primary intraocular lens
• A secondary intraocular lens implanted later

The choice depends on:

• The child’s age
• Eye size
• Corneal diameter
• Associated abnormalities
• Whether one or both eyes are affected
• Family ability to manage contact lenses
• Expected refractive growth
• Surgeon judgement

Why Might a Baby Not Receive an IOL Immediately?

An infant’s eye grows considerably.

An IOL power that is appropriate during infancy may become increasingly inaccurate as the eye lengthens.

Primary IOL implantation in very young infants may also increase the risk of:

• Visual-axis opacification
• Additional surgery
• Inflammation
• Refractive unpredictability
• IOL-related complications

The Infant Aphakia Treatment Study found broadly similar long-term visual acuity between infants treated with contact lenses and those receiving primary IOLs after unilateral infantile cataract surgery, but more adverse events and additional procedures occurred in the primary-IOL group.

Are Contact Lenses Safe for Babies?

Contact lenses can successfully correct aphakia in infancy when parents receive training and maintain appropriate follow-up.

They require:

• Daily handling
• Cleaning and replacement
• Regular power adjustments
• Monitoring for redness or infection
• Prompt review if the lens is lost or displaced

Consistent optical correction is critical. Leaving the operated eye uncorrected allows severe amblyopia to develop even when the cataract surgery itself was technically successful.

What Is Amblyopia Treatment?

Amblyopia means reduced vision caused by abnormal visual development rather than a structural problem that fully explains the visual loss.

After unilateral cataract surgery, the clearer fellow eye may continue dominating.

Treatment may therefore involve patching the stronger eye for prescribed periods so that the brain is encouraged to use the operated eye.

Amblyopia management may include:

• Correct spectacles or contact lens
• Patching
• Atropine penalisation in selected situations
• Monitoring eye alignment
• Regular visual-acuity assessment

Patching must be individualised. Too little may fail to stimulate the weaker eye, while excessive patching can interfere with the stronger eye or binocular development.

Is Surgery Alone Enough?

No.

Successful childhood cataract management requires three connected components:

1. Clear the visual axis
2. Provide accurate optical correction
3. Treat amblyopia and monitor visual development

A technically excellent operation may still lead to poor vision if:

• Contact lenses are not worn
• Spectacles are inaccurate
• Patching is inconsistent
• Follow-up is missed
• Visual-axis opacification develops
• Glaucoma is not detected

Treatment is therefore a long-term partnership involving the child, family, ophthalmologist, optometrist and paediatric team.

What Are the Risks of Childhood Cataract Surgery?

Possible risks include:

• Infection
• Inflammation
• Raised eye pressure
• Glaucoma
• Visual-axis opacification
• Posterior capsule clouding
• Pupil irregularity
• Corneal problems
• IOL displacement
• Retinal complications
• Residual refractive error
• Need for additional surgery
• Persistent amblyopia
• Strabismus

Children generally produce a stronger inflammatory response than adults and require more intensive postoperative monitoring.

What Is Visual-Axis Opacification?

Cells remaining after surgery may proliferate and create a cloudy membrane across the visual axis.

This is particularly common in young children.

It may cause:

• Declining vision
• Loss of fixation
• Recurrent white reflex
• Reduced visual development

Treatment may require:

• YAG laser in a cooperative older child
• Surgical membranectomy
• Additional vitrectomy

Visual-axis opacification is among the commonest reasons for additional surgery after cataract removal in infancy.

Can Glaucoma Develop After Childhood Cataract Surgery?

Yes.

Glaucoma following cataract surgery is an important long-term risk, especially when surgery is performed during infancy.

It may develop:

• Soon after surgery
• Several years later
• During adolescence
• In adulthood

Glaucoma may occur whether or not an IOL was implanted.

Long-term studies show that glaucoma-related adverse events remain common after infantile cataract surgery, which is why lifelong eye-pressure and optic-nerve monitoring is required.

Does an Early Operation Cause Glaucoma?

Surgery at a younger age is associated with a greater glaucoma risk, but delaying a visually significant cataract may cause irreversible deprivation amblyopia.

The treatment decision therefore balances:

• The need to restore a clear image early
• Anaesthetic and surgical risk
• Glaucoma risk
• Visual-axis opacification
• Long-term visual potential

The existence of surgical risks does not mean that a dense infantile cataract should simply be left untreated.

Will a Child Need Glasses After Surgery?

Usually, yes.

Even when an IOL is implanted, spectacles may be needed for:

• Residual short-sightedness or long-sightedness
• Astigmatism
• Near focusing
• Protection of the better eye
• Changing prescription as the eye grows
• Amblyopia treatment

A young child cannot rely on an artificial lens to change focus like a healthy natural lens.

The prescription may change substantially during childhood, requiring regular review.

Can the Cataract Grow Back?

The removed natural lens cataract cannot grow back.

However, vision can become cloudy again because of:

• Visual-axis opacification
• Posterior capsule opacification
• Inflammatory membrane
• IOL deposits
• Another eye condition

Parents sometimes describe this as the cataract returning, but it represents clouding of tissue left behind rather than regeneration of the natural lens.

What Is the Long-Term Outlook?

Visual outcome depends on:

• Age at onset
• Age at treatment
• Cataract density
• Unilateral versus bilateral disease
• Associated eye abnormalities
• Quality of optical correction
• Amblyopia treatment
• Family adherence
• Development of glaucoma or other complications

Some children achieve very useful vision after early treatment and consistent rehabilitation.

Others may retain limited vision because of:

• Delayed diagnosis
• Severe deprivation amblyopia
• Nystagmus
• Abnormal eye development
• Retinal or optic nerve disease
• Glaucoma
• Repeated visual-axis opacification

Modern surgery and amblyopia management have improved outcomes substantially, but long-term supervision remains essential.

Is Cataract Surgery Different in a Teenager or Young Adult?

In an otherwise normally developed eye, surgery in a teenager or young adult is generally more similar to adult cataract surgery.

The procedure commonly involves:

• Phacoemulsification or aspiration of the cataract
• Preservation of the capsular bag
• Implantation of an IOL
• Postoperative anti-inflammatory medication

However, planning may still differ because younger patients have:

• Larger remaining accommodative needs
• A longer lifetime with the IOL
• Greater concern about retinal detachment in high myopia
• Greater sensitivity to the loss of natural near focusing
• Different expectations regarding spectacle independence
• Possible systemic or inflammatory causes requiring treatment

Does Cataract Surgery Remove Natural Near Focusing?

Yes.

The natural lens provides accommodation—the ability to change focus between distance and near.

Once the lens is removed, this natural accommodative function is lost.

A young patient with a monofocal IOL may require:

• Reading glasses
• Computer glasses
• Progressive spectacles
• A monovision strategy
• Another presbyopia-management plan

Multifocal, trifocal or extended-depth-of-focus IOLs may reduce spectacle dependence in selected patients, but they involve trade-offs such as halos, glare and reduced contrast. They are not suitable for every young cataract patient.

Should an Early Cataract Trigger a General Medical Check?

Often, yes.

A cataract developing unusually early may justify review of:

• Diabetes
• Steroid exposure
• Previous trauma
• Atopic disease
• Uveitis
• High myopia
• Previous surgery
• Radiation exposure
• Family history
• Metabolic symptoms

The required investigation depends on whether the cataract is:

• Unilateral or bilateral
• Stable or rapidly progressing
• Congenital or newly acquired
• Associated with other ocular findings
• Accompanied by systemic symptoms

Not every young adult requires extensive genetic or metabolic testing, but an early cataract should not automatically be labelled age-related without considering the context.

Can Young-Person Cataracts Be Prevented?

Not every congenital, genetic or developmental cataract can be prevented.

Potentially avoidable risks may be reduced through:

• Appropriate vaccination and antenatal care
• Good diabetes control
• Protective eyewear for sport and hazardous work
• Treatment of uveitis
• Avoiding unsupervised steroid use
• Appropriate ultraviolet and radiation protection
• Avoiding habitual forceful eye rubbing
• Early examination after eye trauma
• Regular eye screening when systemic disease increases risk

These measures reduce certain risks but cannot guarantee that cataract will never occur.

Can Eye Exercises, Supplements or Eyedrops Remove a Cataract?

No established eye exercise, vitamin or routine eyedrop reliably removes a cataract.

Treatment may involve:

• Observation
• Spectacles
• Contact lenses
• Amblyopia management
• Surgery

When a cataract significantly blocks the visual axis, delaying effective treatment in favour of unproven remedies may allow irreversible amblyopia to develop.

When Should a Baby or Child Be Assessed Urgently?

Prompt assessment is required for:

• A white, grey or abnormal pupil
• Repeated white reflex in photographs
• An absent or unequal red reflex
• A new eye turn
• Poor fixation or visual following
• New nystagmus
• Sudden visual behaviour change
• Eye trauma
• Significant eye pain or redness
• A rapidly developing lens opacity
• A child covering or closing one eye
• Unexplained loss of school or sports performance

A white pupil should be treated as a sign requiring diagnosis, not as proof that the child simply has a cataract.

When Should a Teenager or Young Adult Seek Review?

Arrange an eye examination for:

• Gradual painless blur
• Increasing glare
• Halos
• Night-driving difficulty
• Frequent spectacle changes
• Increasing short-sightedness
• One eye becoming progressively worse
• Monocular ghosting or double vision
• Reduced colour or contrast
• A history of eye injury
• Long-term steroid use
• Diabetes or uveitis

Seek urgent care for:

• Sudden vision loss
• Severe pain
• Marked redness
• Significant discharge
• New flashes
• A sudden shower of floaters
• A curtain-like shadow
• Penetrating eye injury
• Chemical or projectile injury

These are not typical symptoms of an uncomplicated slowly developing cataract.

Frequently Asked Questions

Can a Baby Be Born With Cataracts?

Yes.

These are called congenital cataracts.

Can Cataracts Develop During Childhood?

Yes.

They may be genetic, developmental or acquired because of trauma, inflammation, medication or illness.

Can Teenagers Develop Cataracts?

Yes.

Possible causes include eye trauma, steroids, uveitis, diabetes, atopy, genetics, radiation and previous eye surgery.

Can Someone in Their Twenties Develop a Cataract?

Yes.

A cataract at this age is uncommon but possible and may justify investigation for an underlying cause.

Are Childhood Cataracts Always Genetic?

No.

They may be genetic, infectious, metabolic, traumatic, inflammatory, medication-related, developmental or unexplained.

Are Cataracts in Both Eyes More Likely to Be Genetic?

Bilateral childhood cataracts are more likely than isolated unilateral cataracts to have a genetic, metabolic or systemic association, but this is not an absolute rule.

Can a Cataract Affect Only One Eye?

Yes.

Unilateral cataracts may result from:

• Trauma
• Abnormal eye development
• A sporadic congenital cataract
• Local inflammation
• An unexplained cause

Can a Child See Through a Cataract?

It depends on the cataract’s size, density and position.

A small peripheral opacity may have little effect, while a dense central cataract can severely obstruct vision.

Is a White Pupil Always a Cataract?

No.

A white pupil can be caused by several conditions, including retinal disease and retinoblastoma.

It requires prompt assessment.

Can Flash Photography Detect Cataracts?

A repeated abnormal white reflex in one eye may reveal a cataract or another eye problem.

One isolated photographic reflection may be an artefact, but repeated asymmetry should be examined.

Can Cataracts Cause a Squint?

Yes.

Poor vision in one eye may cause it to turn inwards or outwards.

Can Cataracts Cause Nystagmus?

Dense cataracts affecting both eyes during early development may cause sensory nystagmus.

Will a Small Cataract Need Surgery?

Not always.

Small, stable opacities that do not obstruct vision may be monitored.

Why Must Infant Cataracts Be Treated Early?

A clear image is required for the brain’s visual pathways to develop normally.

Prolonged deprivation may cause irreversible amblyopia.

Does Earlier Surgery Always Produce a Better Result?

Early clearing of a dense cataract supports visual development, but surgery during infancy carries greater risks such as glaucoma and visual-axis opacification.

Timing must be individualised.

Is an Artificial Lens Always Put Into a Baby’s Eye?

No.

Some infants are initially left aphakic and corrected with a contact lens.

An IOL may be implanted later.

Can Babies Wear Contact Lenses?

Yes.

Contact lenses are commonly used to correct aphakia after infantile cataract surgery, but they require careful family training and regular follow-up.

Why Is Patching Needed After Surgery?

Patching encourages the brain to use the weaker operated eye and helps treat amblyopia.

Can Patching Restore All the Vision?

Not always.

The result depends on how long the image was obstructed, treatment timing, adherence and associated eye abnormalities.

Can Childhood Cataract Surgery Cause Glaucoma?

Yes.

Glaucoma may develop years after surgery, so long-term monitoring is required.

Does the Cataract Grow Back?

No.

The removed lens cannot regrow, but the visual axis or posterior capsule may become cloudy.

Will the Child Need More Surgery?

Possibly.

Additional treatment may be needed for:

• Visual-axis opacification
• Glaucoma
• Strabismus
• IOL problems
• Secondary IOL implantation

Will Glasses Still Be Needed?

Usually.

A child’s eye grows and the prescription changes over time.

Can Steroid Inhalers Cause Cataracts?

Long-term or substantial corticosteroid exposure may increase cataract risk, but medically necessary inhalers should not be stopped without consulting the prescribing doctor.

Can Diabetes Cause Cataracts in Teenagers?

Yes.

Poorly controlled diabetes can accelerate lens clouding and cause rapidly changing vision.

Can Sports Injuries Cause Cataracts?

Yes.

Both blunt and penetrating injuries can damage the natural lens.

Protective eyewear is important for high-risk activities.

Can Young-Person Cataracts Be Dissolved With Drops?

There are currently no established eyedrops that reliably dissolve congenital, traumatic or early-onset cataracts.

Key Takeaway

Young people can develop cataracts.

Cataracts may be:

• Present at birth
• Detected during infancy
• Progressive during childhood
• Acquired during adolescence
• Early onset in young adulthood

Possible causes include:

• Genetics
• Problems during pregnancy
• Metabolic conditions
• Abnormal eye development
• Trauma
• Uveitis
• Corticosteroids
• Diabetes
• Atopy
• High myopia
• Previous eye surgery
• Radiation
• An unknown cause

Warning signs in babies and children include:

• A white pupil
• An abnormal red reflex
• Poor visual following
• Strabismus
• Nystagmus
• One eye appearing different in photographs

Symptoms in teenagers and young adults include:

• Gradual blur
• Glare
• Halos
• Poor night vision
• Frequent spectacle changes
• Increasing short-sightedness
• Monocular ghosting
• One eye becoming worse

Not every childhood cataract needs surgery.

Small peripheral cataracts may be monitored, but a dense central cataract may require early treatment to prevent deprivation amblyopia.

Successful management involves more than removing the lens. It may require:

• Cataract surgery
• Contact lenses or an IOL
• Spectacles
• Patching
• Strabismus management
• Repeated prescription changes
• Lifelong monitoring for glaucoma

A persistent white pupil or abnormal red reflex requires prompt assessment because cataract is only one of several possible causes.

Early diagnosis provides the best opportunity to preserve visual development and achieve useful long-term vision.

References

1. National Eye Institute. Types of Cataract: Pediatric Cataracts. Updated August 2025.
2. Chen SP, et al. Cataracts: A Review. 2025. PMID: 40227658.
3. Lloyd IC. Update on Pediatric Cataract Surgery. 2025. PMID: 40780670.
4. Lenhart PD, et al. Current Management of Infantile Cataracts. 2022. PMID: 35307324.
5. Mohammadpour M, et al. Updates on Managements of Pediatric Cataract. 2018. PMID: 31317088.
6. Lloyd IC, et al. Advances in the Management of Congenital and Infantile Cataract. 2007. PMID: 17914433.
7. Oshika T, et al. Ten-Year Outcomes of Congenital Cataract Surgery. 2024. PMID: 38517986.
8. Lambert SR. What We Have Learned From the Infant Aphakia Treatment Study. 2023. PMID: 37716436.
9. Lambert SR, et al. Long-Term Effect of Intraocular Lens Versus Contact Lens Treatment After Unilateral Cataract Surgery During Infancy. 2020. PMID: 32077909.
10. Lambert SR, et al. Comparison of Contact Lens and Intraocular Lens Correction After Infantile Cataract Surgery. 2014. PMID: 24604348.
11. Repka MX, et al. Visual Acuity and Ophthalmic Outcomes Five Years After Lensectomy in Children. 2022. PMID: 35142808.
12. Whitman MC, VanderVeen DK. Complications of Pediatric Cataract Surgery. 2014. PMID: 25325868.
13. Praveen MR, et al. Risk Factors for Early-Onset Cataract in Young Adults. 2010. PMID: 19521430.
14. Midha NK, et al. Rapidly Developing Cataract in Young Adult Patients. 2021.
15. Kirwan C, et al. Glaucoma in Aphakic and Pseudophakic Eyes Following Surgery for Congenital Cataract. 2010. PMID: 19758403.
16. Sachdeva V, et al. Second Intraocular Surgery After Primary Pediatric Cataract Surgery. 2016. PMID: 27472208.
17. Cromelin CH, et al. Association of Contact Lens Adherence With Visual Outcome in the Infant Aphakia Treatment Study. 2018. PMID: 29423513.
18. Balmer A, Munier F. Differential Diagnosis of Leukocoria and Strabismus in Infants. 2007.