All newborns should have a screening eye examination performed by their primary care provider, including an evaluation of the red reflex. Retinoscopy through an undilated pupil is helpful for assessing the potential visual significance of an axial lens opacity in a preverbal child. Table 23-3 summarizes the evaluation of pediatric cataracts.
The clinician should obtain a history of the child’s growth, development, and systemic disorders, in addition to a family history, as this information can help guide the evaluation. For example, a patient with acquired cataract and intractable diarrhea should be evaluated for the treatable metabolic disorder cerebrotendinous xanthomatosis. A slit-lamp examination of immediate family members can reveal previously undiagnosed lens opacities that are visually insignificant but that may indicate an inherited cause for the child’s cataracts. Congenital posterior sutural cataracts, for example, develop in female carriers of X-linked Nance-Horan syndrome, and mild lenticular opacities develop in female carriers of Lowe (oculocerebrorenal) syndrome by puberty.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.