This opinion piece revisits and considers the spiritual dimensions of occupation and occupational therapy practice. It discusses the dilemmas inherent in such an exploration and suggests ways of looking at different aspects, drawing from some of the literature on this topic. Views are put forward as to whether or not spirituality is a legitimate sphere in which occupational therapists should engage and issues of ongoing debate are highlighted.

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Purpose We reviewed all children presenting with microcephaly and bilateral congenital cataract in our paediatric cataract clinic, to identify their underlying diagnosis and clinical features that could help in early diagnosis of such conditions. Methods We screened our cataract database to collect data on all children presenting to our institute with cataract before 1 year of age for a period of 5 years (1997)(1998)(1999)(2000)(2001) inclusive. We found 166 cases of cataract, of which 85 were bilateral. Of the 85 children with bilateral cataract, five also had microcephaly. The case notes of these five children were retrospectively reviewed for age at presentation, ocular and systemic examination findings, results of electro diagnostic testing, outcome of cataract surgery, and any additional investigation results. Results In our series, three children were diagnosed with early-onset Cockayne syndrome (CS2), one was diagnosed with Micro syndrome and one with HallermannStreiff syndrome. Electrodiagnostic testing was abnormal in four of the five cases, and growth failure was present in all five. There was a good outcome from surgery in the three children with CS2 and the child with Hallermann-Strieff. There was a poor outcome in the child with Micro syndrome. Conclusions The presence of microcephaly in children presenting with bilateral cataracts in infancy is strongly suggestive of a syndromic cause. Early-onset Cockayne syndrome was the commonest underlying diagnosis in our series, but clinicians should be aware of other possibilities, and we discuss the differential diagnosis. Head circumference should be checked routinely in children with congenital cataract.

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