The variety of causative factors in childhood cataracts, ranging from dominant inheritance to basketball-related trauma, requires great flexibility on the part of the surgeon and many options for surgical approaches and rehabilitative modalities. The search for specific genetic errors that result in cataract may eventually lead to curative gene therapy, but probably not in the near future. For now, trauma prevention, including protective eye wear for sports enthusiasts, and improvements in surgical techniques that reduce postoperative complications offer more immediate benefits. Some increase in acceptance of intraocular lens implantation in children may provide data for long-term effects of the presence of these foreign bodies in human eyes. Contact lenses are generally believed to be the best option for visual rehabilitation, with epikeratophakia and intraocular lenses reserved for selected cases. Visual results in children with associated ocular or systemic disorders remain poor, and solutions to their problems await future research.