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Cataract

DESCRIPTION: A clouding or opacity of the lens, believed to be caused by chemical changes in the lenticular structure/material. Etiology includes: hereditary, congenital anomalies associated with disease or syndrome; infection, severe malnutrition, or drugs during pregnancy; systemic disease (e.g., diabetes); trauma (e.g., head injury or puncture wound); normal manifestation of old age. May be congenital, senile, or traumatic. Symptoms include whitish appearance of the pupil and blurred vision/decreased acuity (especially at distance). The congenital type may also include nystagmus, squint, photophobia; traumatic cataract symptoms include general redness and irritation of the eye, and may be complicated by infection, uveitis, retinal detachment, and glaucoma.

TREATMENT: There is no medical treatment - only surgical. Congenital cataracts (not caused by rubella) should be removed within the first few months of life if acuity is to develop normally; contact lenses or glasses provide the accommodative power of the missing lens. (Depending on the type of surgery, secondary cataracts sometimes reappear, and repeat surgery is necessary.) Senile cataract removal is followed by one or more of the following: cataract glasses, contact lenses, or intraocular lens implant. Complications of cataract surgery include vitreous and/or retinal detachments and glaucoma.

IMPLICATIONS: Variable lighting to reduce glare in persons with unoperated cataracts. Lighting should be from behind to reduce glare. NOTE: Children with cataracts caused by maternal rubella usually do not have surgery until at least age 2, since the live virus is present in ocular tissues many months after birth. Such children have less favorable prognoses for good acuity following surgery, since the period for retinal stimulation has passed.

Genetic counseling may be indicated.

Educational note: A child with a central, unoperated cataract may have some unusual head positions; these should be tolerated, since the child is essentially "looking around the cataract." Magnification is helpful in some cases.

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