Postpartum Visual Changes

Vidushi Gupta, B.Optom

Optometrist, Dr. Shroff Charity Eye Hospital, New Delhi, India

Women undergo a tremendous number of changes, both systemic and ocular, throughout pregnancy and even post-partum. During pregnancy, physiological changes occur in the cardiovascular, hormonal, metabolic, hematologic, and immunologic systems. The placenta, maternal endocrine glands and the foetal adrenal glands combine their productivity to make a high-powered hormone factory. The immune state is suppressed, leaving the pregnant woman more susceptible to serious immunological disorders. By some of these mechanisms, pregnancy causes ocular changes which may be more commonly transient but occasionally, permanent. ⁽¹⁾

Acute vision loss in the post-partum period can occur due to many reasons. Eclampsia, posterior reversible encephalopathy syndrome (PRES), pituitary apoplexy, Postpartum cerebral angiopathy and central serous retinopathy are some of the important causes. ⁽¹⁾

Postpartum preeclampsia is a condition that affects some women after giving birth. It occurs when a woman who had gestational hypertension or preeclampsia during pregnancy continues to have high blood pressure and evidence of damage to organs such as the liver, kidneys, brain, or blood cells after delivery. Visual disturbances such as blurring of vision and photopsia are commonly seen among women with pre-eclampsia/eclampsia, but complete loss of vision is an uncommon neurological complication of preeclampsia. The conditions which lead to visual loss in pre-eclampsia and eclampsia include cortical blindness, retinal detachment, retinal vascular thrombosis, and optic nerve atrophy. ⁽²⁾

Posterior Reversible Encephalopathy Syndrome (PRES) is a rare but potentially serious condition that affects the brain. It is characterised by a sudden onset of headache, confusion, seizures, and visual changes, which can lead to more severe symptoms such as loss of consciousness, paralysis, or coma. The exact cause of PRES is not fully understood, but it is believed to be related to changes in blood flow in the brain and fluctuations in blood pressure. Ophthalmic manifestations of PRES are visual disturbances including decreased visual acuity, visual field deficits, cortical blindness, or hallucinations. ⁽³⁾

Pituitary apoplexy is a medical emergency that occurs when the pituitary gland, a small gland located at the base of the brain, experiences sudden bleeding or swelling. This can lead to the compression of surrounding structures, including the optic nerve, which can cause vision loss. Vision loss in pituitary apoplexy can range from mild vision disturbances to complete blindness in one or both eyes. The severity and duration of vision loss depend on the extent of the damage to the optic nerve and surrounding structures. The classic visual field defect is a bitemporal superior quadrantic defect from compression of the optic chiasm from below; however, field defects will show more diffuse loss with greater chiasmal fibre damage. ⁽⁴⁾

Postpartum cerebral angiopathy (PCA) is a rare but potentially serious condition that affects some women after giving birth. It is characterised by a sudden onset of headache, confusion, seizures, and vision changes, which can progress to more severe symptoms such as loss of consciousness, paralysis, or coma. PCA is believed to be related to changes in the blood vessels in the brain after delivery, which can cause blood clots and swelling in the brain. ⁽⁵⁾

Cryptococcal meningitis can cause acute vision loss in the postpartum period. Cryptococcal meningitis is a fungal infection that affects the membranes surrounding the brain and spinal cord, causing symptoms such as headache, fever, and neck pain. In some cases, the infection can spread to the eyes and cause vision loss. ⁽⁶⁾

In conclusion, postpartum vision loss is a rare but serious condition that can occur after childbirth. Prompt medical attention is crucial for the diagnosis and treatment of postpartum vision loss. Women who experience changes in their vision after childbirth should seek medical care immediately. Preventative measures, such as regular prenatal care and monitoring of blood pressure, can help reduce the risk of developing this condition. It is important for healthcare providers to be aware of this condition and to monitor patients closely during and after childbirth.

References:

1. Garg, P., & Aggarwal, P. (2012). Ocular changes in pregnancy. Nepalese Journal of Ophthalmology, 4(1), 150-161.
2. Radha Bai Prabhu, T. (2017). Serious visual (ocular) complications in pre-eclampsia and eclampsia. The Journal of Obstetrics and Gynecology of India, 67, 343-348.
3. Lifson, N., Pasquale, A., Salloum, G., & Alpert, S. (2019). Ophthalmic manifestations of posterior reversible encephalopathy syndrome. Neuro-Ophthalmology, 43(3), 180-184.
4. Pituitary apoplexy: A syndrome of acute visual dysfunction. American Academy of Ophthalmology. (2013, February 18). Retrieved March 18, 2023, from https://www.aao.org/education/current-insight/pituitary-apoplexy-syndrome-of-acute-visual-dysfun
5. Lee, S. Y., Sheen, S. H., Lee, S. H., Kim, S. S., Kim, C. H., Yie, K. S., & Kim, S. H. (2011). Postpartum cerebral angiopathy presenting with non-aneurysmal subarachnoid hemorrhage. Journal of Clinical Neuroscience, 18(9), 1269-1271.
6. Lee, A. G., Karimaghaei, C., Mortensen, P. W., Raviskanthan, S., Al-Zubidi, N., & Suleiman, A. O. Neuro-ophthalmic Manifestations of Cryptococcal Meningitis. [https://eyewiki.org/Neuro-ophthalmic_Manifestations_of_Cryptococcal_Meningitis, Last accessed: 20Mar2023, 6:15pm AEDT]