Congenital cataracts presenting as a childhood squint

Aim: A timely reminder that a small posterior subcapsular cataract could present with a squint. Methods: A case series is reported of 4 patients who were referred to the paediatric ophthalmology service for management of a squint. Results: In all 4 cases the strabismus was secondary to the undiagnosed posterior subcapsular cataract. Conclusion: These cases emphasise the importance of carefully examining the red reflex in any child presenting with a squint. If the squint does not fit into the typical pattern of presentation, or a smudge appears to be present when performing retinoscopy or indirect ophthalmoscopy, a further assessment of the media using a direct ophthalmoscope or a slit lamp should be undertaken to check for a congenital cataract. A portable slit lamp can be very helpful in examining small children.