Catarata em crianças: aspectos clínicos e avaliação

Abstract

Introduction: Cataract is the opacity of the eye's lens that causes partial or total visual loss. It is a common and often curable cause of blindness in children. Early detection and immediate intervention are essential for good visual results, especially in newborns. The reported prevalence of childhood cataracts ranges from 1 to 15 per 10,000 children. When congenital, there is a prevalence of 1 to 3 per 10,000 children, with an autosomal dominant pattern in 10 to 25% of cases. Slit lamp examination of the biological parents will occasionally reveal subtle lentil changes. If there is a positive family history, the newborn should be referred directly to an ophthalmologist. In 1/3 of cases, there are secondary causes and in the remaining 1/3, idiopathic factors. Objective: to discuss the diagnosis of cataracts in children. Methodology: Integrative literature review from Scielo, PubMed and VHL databases, from March to May 2024, with descriptors “cataract”, “babies”, “young children” and “pre-teens”, registered in DeCS /MeSH and “AND” operator. Articles from 2019-2024 (total 46) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: The clinical presentation varies: parental complaint (cataract visible to the naked eye as it is anterior); positive family history; gaze deviation; red reflex asymmetry; leukocoria (white pupillary reflex); nystagmus; strabismus; photophobia; developmental delay or extraocular diseases. Assessing the red reflex in old photographs can help determine age of onset and visual prognosis. Cataracts can be stationary or progressive. Most progress, especially in the early amblyogenic period (from birth to 5 years of age), when amblyopia results in more visual loss and is more responsive to treatment. The degree of amblyopia depends on the density of the cataract and its age at onset. The earlier the onset of lens opacification and the denser the opacification, the deeper the resulting amblyopia. Visually significant cataracts that are present in the first six months of life are a true ophthalmic emergency. If left untreated, they will result in irreversible vision loss. Regular eye care is crucial for successful outcomes in children who have undergone cataract surgery. Conclusion: Cataract management depends on the age at presentation and the potential for interference with visual development. If the cataract is visually significant, management involves lens removal and optical/visual rehabilitation, which is critical to preventing amblyopia.