Vision and Pregnancy

Pregnancy is a very significant period in every woman’s life. During these nine months, the female body undergoes many changes, which can sometimes result in the appearance of problems related with the normal function of the various systems of the body. Among these changes, there is the possibility that the eyesight may be affected as well, making its regular monitoring necessary.

The onset of myopia or the worsening of already existent myopia is a possible side effect of the hormonal changes that take place during pregnancy. Furthermore, a possible side effect includes a temporary change in focusing and adjustment. Usually, these conditions are temporary and after birth vision is restored to normal.

Since changes in vision may be a symptom of other conditions, it is necessary to be submitted to eye examinations during the pregnancy. Unfortunately, most future mothers do not include this examination in the traditional antenatal assessment, mainly due to the myth that the use of eye drops for the dilation of pupil (mydriasis) is prohibited. On the contrary, the eye examination that includes mydriasis is a safe procedure and moreover, in certain cases, it may even be an important preventive action.

Probable eye-related changes during pregnancy.

• Cornea: The cornea is the transparent membrane in the anterior segment of the eye. It is possible that due to hormonal changes, the cornea might exhibit a small difference in its curvature and thickness (edema), thus causing an intolerance to contact lenses. Due to the reduced production of tears, xerophthalmia (dry eye) may develop hindering even further the use of contact lenses. Dry eye symptoms include blurred vision and can be reduced with artificial tears. At the same time, the use of contact lenses during pregnancy may pose some risks, as the changes that normally occur in the cornea (decreased sensitivity and sentience) may cover up a minor injury or a possible infection, thus causing these conditions to remain unnoticed. The symptoms mentioned above go away after birth and lactation and women can continue using contact lenses as before.
• Photophobia (Light sensitivity): Great sensitivity to light, caused due to hormonal changes, may result in headaches and migraines.
  Visual Acuity: Often, a change of glasses may be required due to changes in refraction. This situation is due to hormonal changes during pregnancy and is usually reversible, which is why we generally avoid changing glasses. It should be emphasized though, that blurred vision may be caused due to gestational diabetes and thus the physician must always be informed about changes in eyesight.
• Visual fields: In some cases, changes in the visual fields, such as partial loss of the visual field at the temporal lobe or the magnification of the blind spot have been reported, all of which are conditions that are fully restored after birth and do not require further examination.
• Central Serous Retinopathy: It has been observed mainly in the third trimester and subsides automatically during the first months after giving birth.
• Pre-eclampsia – Eclampsia: Pre-eclampsia is characterized by the appearance of hypertension (high blood pressure) in women who usually had normal blood pressure. It is observed in 5% of pregnant women, usually after the 20th week. If hypertension is accompanied by shivers, it is called eclampsia. The most common symptom is blurry vision; however, other symptoms may appear as well, including headaches, photopsias and double vision. 10% of women with eclampsia may develop retinal edema, serous detachment or acute ischemic optic neuritis. These conditions are normally reversed 1-2 weeks after blood pressure has been regulated or after labor.
• High myopia: Most women with medium to high myopia are usually worried about the consequences an intense natural labor may have on their eyes and usually resort to C-section. Research, however, disproved this as a myth many years ago, as statistics in groups of women with -4.5 to -15.0 diopters, even in women with pre-existing myopic damage of the fundus, tears or detachments that were restored with laser or surgically, showed there was no deterioration or recurrence of these conditions after natural labor.

Pre-existing conditions that can cause changes in the eyesight during pregnancy

• Hypertension: Blood pressure monitoring is required for the entire duration of pregnancy as, in many occasions, an increase in blood pressure has been observed. Hypertension in pregnancy is accompanied by blurred vision, objects distortion and the perception of bright spots in our visual field. When arterial pressure is not regulated, it may lead to vessel damage, as well as aggravation of other conditions.
• Diabetic Retinopathy: Pregnancy may have a negative effect on pre-existing diabetic retinopathy. The aggravation is affected by various factors, including the duration of the disease, the severity of the conditions prior to the pregnancy, high glycosylated hemoglobin levels and the concurrent appearance of hypertension. 10% of women with diabetes are diagnosed with diabetic retinopathy during pregnancy but only 0.2% exhibit degenerative lesions, which go away after labor. Therefore, regular eye examinations may be required, depending on the type and severity of retinopathy.
• PURTSCHER Retinopathy: Its symptoms include reduced eyesight, floaters and hemorrhages in the fundus of the eye. No treatment is required and the symptoms subside after several weeks.
  Glaucoma: There have been reported cases, where the intraocular pressure has been reduced and the condition has improved, but this data requires further proof, since all changes during pregnancy are reversible.
• Pituitary adenoma: The adenoma may increase in size causing changes in our visual field (usually temporal lobe deficits) or headaches and a decrease in visual acuity. A probable cause of the enlargement of the pituitary adenoma is pituitary apoplexy, which could potentially be dangerous for the patient’s life. Women whose adenoma tends to increase in size and who suffer from headaches are advised to undergo an MRI. If the MRI shows subarachnoid hemorrhages, a C-section may be recommended. As a rule, adenomas reduce in size after labor and do not cause permanent eye damages.

Symptoms that require a visit to the ophthalmologist.

Women, who during pregnancy experience headaches, blurred vision and changes in their visual field need to be submitted to a blood pressure test, a fundoscopy and an examination of their visual fields by the ophthalmologist.

Refractive Surgeries

During pregnancy and lactation, refractive surgeries (laser surgery for the correction of myopia, hyperopia and astigmatism) should be avoided, mainly due to changes on the cornea during this period from hormone changes, which may lead to an unpredictable result. After lactation and once the cornea and the lacrimal layer have been restored along with any other conditions which may have appeared during pregnancy, such a procedure may be scheduled. If surgery was performed before the pregnancy, natural labor does not pose any risk since all changes, as in the previous case, subside after labor.

Use of eye drops

1. The local anesthetics (mydriatics and eye drops for pupil miosis) used during a typical eye evaluation are perfectly safe.
2. Anti-glaucoma eye drops and more specifically beta-blockers need to be administered at the lowest possible dosage during the first trimester, while their use needs to stop 2-3 days prior to labor.
3. Systemic antibiotics should be avoided during pregnancy and lactation.
4. The use of local steroids and antibiotics, such as erythromycin and quinolones is not counter indicated.

Consequently, an eye evaluation needs to be part of the antenatal assessment as not only is it a perfectly safe procedure for both the mother and the embryo but also because it is a very important prevention tool, since changes in eye sight may be a sign of more serious conditions during pregnancy.

Finally, keep in mind: Your ophthalmologist is the best source for responsible information on issues that are related to the health of your eyes. Under no circumstances is the information available on our website intended to replace your doctor. Always contact your doctor for information.