Cataract

Clinical Description

Opacification or clouding of the natural intraocular lens. Associated with advanced age, diabetes mellitus, uveitis, trauma, steroid use, congenital

Signs and Symptoms

• Painless, gradual loss of vision at distance or near, Glare, Increasing near- sightedness that quickly reverses, Loss of contrast sensitivity and ability to discern colours Leukocoria or absence of red reflex

Investigations

• RBS

Treatment

• Surgical
• Small incision cataract surgery (SICS) with intraocular lens implantation
• Phacoemulsification
• Pre-op care:
• Dilation: tropicamide +/- phenylephrine
• Anaesthesia: lignocaine 2% with hyaluronidase given as subtenon, peribulbar or retrobulbar injection
• Post-op care:
• Analgesic of choice for 5 days, Neodex combination eye drops 6 hourly for 3 weeks

OR

• Dexamethasone eye drops 6 hourly and Gentamicin eye drops 6 hourly for 3 weeks

Complications

• subluxated/dislocated lens, uveitis, glaucoma, blindness
• Referral criteria to a cataract operating centre
• Best corrected visual acuity of 6/60 or less
• Refer ALL children with cataract