The management of cataracts is a greater challenge in children than in adults because of the various causes and the plasticity of the developing visual system. The need for early diagnosis and treatment of visually significant childhood cataracts remains paramount, although treatment options are changing. Epikeratophakia lenses are no longer commercially available. Intraocular lenses are being used more frequently; however, complications continue to be reported and in the United States, intraocular lens implantation in children continues to be investigational. Contact lens correction may be shifting from silicone rubber lenses to the less-expensive rigid gas-permeable lenses. For children with uniocular cataracts, better visual outcome may be possible with less stringent preoperative and postoperative patching schedules, and there is evidence that the “sound” eye in these patients is not always as sound as has previously been believed, possibly as a result of amblyogenic central processing deficits or bilateral congenital ocular anomalies.