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Cataract

Cataract is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

Cataract is the term used for any opacification of the crystalline lens of the eye.

Epidemiology

  • Prevalence of childhood cataracts is 1 to 15:10,000, with the range being attributable to reporting, definition, age, and variance in populations.
  • Approximately four children per million total population will be born with bilateral congenital cataracts in developed countries.
  • Adjusted cumulative incidence is 2.49 per 10,000 in the 1st year of life, increasing to 3.46 by age 15 years.

General Prevention

  • There is currently no known way to prevent congenital cataracts. Timely prenatal diagnosis and treatment of intrauterine infections can prevent associated infant morbidities, including secondary cataracts. Correcting an underlying metabolic abnormality and minimizing exposure to inciting agents also reduces risk.
  • It is essential that all newborns (and all children) receive screening eye examinations by health care providers. In much of the world, early diagnosis and referral is still the limiting factor for a child’s ultimate visual prognosis.

Pathophysiology

  • Derangement of the normal developmental growth of the crystalline fibers of the central lens nucleus or peripheral lens cortex. The location of the opacity often suggests the congenital or early acquired onset.
  • Frequently classified according to morphology or etiology
  • Dense central opacities of ≥3 mm are visually significant and may produce visual disability.

Etiology

  • Congenital or developmental: About 2/3 are idiopathic, the remainder being inherited or associated with systemic disorders.
  • Hereditary: Autosomal dominant transmission is responsible for 75% of bilateral hereditary cataracts. Most affected individuals are otherwise healthy.
    • Phenotypically identical cataracts can occur with mutations at different genetic loci, and phenotypically variable cataracts can be found within a single family.
    • Multiple contributing genetic loci have been identified.
    • Rare hereditary syndromes combine cataracts with systemic disease. These are listed in the following discussion.
  • Acquired
    • Toxic: may result from chronic steroid use or radiation exposure
    • Traumatic: may result from either blunt or penetrating ocular trauma
    • Inflammatory: from chronic uveitis
  • Ocular abnormalities: Cataracts may be associated with primary ocular abnormalities such as aniridia, Peters anomaly, coloboma, and microcornea.

Commonly Associated Conditions

  • Prenatal factors: intrauterine infection, fetal alcohol syndrome
  • Metabolic and endocrine:
    • Galactosemia
    • Neonatal hypoglycemia
    • Hypoparathyroidism
    • Diabetes mellitus
    • Homocystinuria
    • Fabry disease
    • Wilson disease
    • Mannosidosis
  • Chromosomal:
    • Trisomy 21 (Down syndrome), 18, 13, or 15
    • Turner syndrome
  • Dermatologic:
    • Congenital ichthyosis
    • Hereditary ectodermal dysplasia
    • Infantile poikiloderma
    • Gorlin syndrome
  • Renal:
    • Lowe syndrome
    • Alport syndromes
  • Musculoskeletal:
    • Marfan syndrome
    • Conradi syndrome
    • Albright syndrome
    • Myotonic dystrophy
  • Rheumatologic:
    • Juvenile idiopathic arthritis
    • Other uveitis (psoriatic, HLA-B27, etc.)
  • Other:
    • Craniofacial and mandibulofacial syndromes
    • Neurofibromatosis

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Citation

Cabana, Michael D., editor. "Cataract." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617203/all/Cataract.
Cataract. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617203/all/Cataract. Accessed April 18, 2019.
Cataract. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617203/all/Cataract
Cataract [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617203/all/Cataract.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Cataract ID - 617203 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617203/all/Cataract PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -