A nurse is assessing a toddler's vision. Which of the following findings is an indication that the toddler has a cataract?

A cataract is an opacity of the lens of the eye that interferes with the normal passage of light to the retina. In toddlers, cataracts can be congenital or acquired and may lead to impaired visual development if not identified early. During eye assessment, the red reflex test is an important screening tool used to detect abnormalities of the lens or retina. Absence or abnormality of the red reflex is a significant finding that requires prompt evaluation. Rationale: A. Closing one eye at a time is more commonly associated with diplopia or strabismus rather than cataracts. A child may close one eye to compensate for misalignment of vision or double vision. Cataracts primarily cause clouding of the lens rather than extraocular muscle imbalance, so this is not the expected finding. B. Absence of red reflex is a classic indication of cataract because the cloudy lens blocks light from reflecting normally off the retina. Normally, when light is directed into the eye, a reddish-orange glow is seen due to reflection from the retina. If the lens is opaque, this reflex is absent or appears white, signaling the need for urgent ophthalmologic assessment. C. Absence of accommodation to light refers more to pupillary abnormalities or neurologic dysfunction rather than cataracts. Cataracts affect lens transparency and vision quality, not the pupil’s direct response to light. The pupillary light reflex may still be present even when a cataract exists. D. Tilting the head to one side is more commonly seen with strabismus or certain visual field disturbances where the child tries to improve alignment or compensate for abnormal vision. It is not a typical hallmark of cataracts. Cataracts are better identified through lens opacity and abnormal red reflex findings rather than head positioning.