Pregnancy-related Ocular Changes and its Management

Sanjukta Jana, B. Optom

Student, NSHM Knowledge Campus, Kolkata, India

 

Women undergo several changes during pregnancy. These changes can be both systemic and ocular. The main interest of this blog is to describe the ocular changes during the gestation period. Pregnancy is intimately associated with ocular changes.

These changes are mostly transient and take place due to hormonal changes occurring in the body during pregnancy leading to fluid retention. Ocular changes can be categorised as follows and discussed simultaneously.

Physiological ocular changes and their management

• Physiological changes are transient and cause minor trouble in vision.
• Usually, these changes do not cause any permanent damage.
• The cornea may become thick and more curved. Hence, blurring of vision takes place. ⁽¹⁾
• The refractive status of the eye is frequently altered during pregnancy due to physiological changes in ocular tissues. ⁽²⁾
• Changing the power of the spectacle or contact lens is not recommended as the refractive error of the eye highly fluctuates from one trimester to other.
• It is not advisable to perform any refractive surgery (LASIK or PRK) during pregnancy and the lactation period.
• There is a noticeable decrease in corneal sensitivity. No treatment is required. Returns to normal within 8 weeks of postpartum. ⁽³⁾
• Dry eye syndrome is the most frequent complication. Increased Vitamin A intake through the consumption of leafy vegetables and omega-3 fatty acids is recommended. Lubricating eye drops or artificial tear drops can be prescribed after consultation with an ophthalmologist.
• Despite the previous success, contact lens intolerance has been reported, due to the increased corneal thickness. ⁽⁴⁾
• Ocular migraine is common during the gestation period, due to estrogen influence.
• During pregnancy, ocular pressure is lesser than normal eye pressure. No treatment is required for this change. After two or three months of delivery of the baby, eye pressure returns to normal. This physiological change is advantageous in the case of acute primary open-angle glaucoma. However, in chronic cases, glaucoma tends to persist.
• A subconjunctival hemorrhage is a usual finding during and after delivery. No protective measures are needed.
• Ptosis (drooping of eyelids) may affect one eye or both eyes of a pregnant woman. The effect on eyelid muscles is caused by increased fluid retention in the levator and increased secretion of the hormone relaxin. Resolves post-partum. However, if ptosis persists after childbirth a proper eye examination is needed to confirm its association with a serious ocular condition. Avoidance of carbohydrate food is helpful to some extent. ⁽²⁾
• Chloasma (skin color changes of eyelids and cheeks) is a common phenomenon observed in 75 % of would-be mothers. They need to be assured that this pigmentation causing cosmetic blemish are temporary and mostly disappear after childbirth. The use of any medications without consultation with a dermatologist may be detrimental to the foetus. ⁽³⁾

Pregnancy-related ocular changes that were not present before and their management

• Gestational diabetes is usual. However, this diabetes does not cause diabetic retinopathy and regresses post-partum.
• In the case of preeclampsia or eclampsia i.e., blood pressure changes in the gestation period eye problems such as blurring of vision, photophobia, double vision, and visual field defect are common. Control of blood pressure is needed, or it can lead to a ⁽²⁾

Pre-existing eye problems and their management

• In the case of pre-existing diabetic retinopathy, a detailed eye examination is necessary. A pre-pregnancy eye examination should be considered while family planning. Visual complaints increase during the gestation period. Follow-ups are mandatory every three months depending on the stage.
• Phenylephrine is avoided because it leads to birth defects.⁽³⁾
• Retinal LASER photocoagulation is safe during pregnancy.
• However, Vitrectomy is delayed.
• In would-be mother glaucoma patients, the application of certain eyedrops is avoided.

This blog has been written with the sole purpose of educating eye care professionals about the management procedure of a pregnant woman.

 

References

1. Yenerel, N. M., & Küçümen, R. B. (2015). Pregnancy and the Eye. Turkish journal of ophthalmology, 45(5), 213–219. https://doi.org/10.4274/tjo.43815
2. Naderan M. Ocular changes during pregnancy. Journal of current ophthalmology. 2018 Sep 1;30(3):202-10.
3. Gupta V. Ocular Changes in Pregnancy. Orange books Publishing; 2019 Jul 9.
4. Samra K. A. (2013). The eye and visual system in pregnancy, what to expect? An in-depth review. Oman journal of ophthalmology, 6(2), 87–91. https://doi.org/10.4103/0974-620X.116626