Pregnancy-Related Eye Changes

Pregnancy-Related Eye Changes - Baby's Eye Perks

• Cornea:
  • ↑ Thickness & curvature (due to edema) → transient myopic shift (avg. -0.5 to -1.0 D), astigmatic changes.
  • Contact lens intolerance common.
• Intraocular Pressure (IOP):
  • ↓ IOP (typically 2-3 mmHg), more pronounced in 2nd/3rd trimesters.
  • Mechanism: ↑ uveoscleral outflow, hormonal effects (progesterone).
• Tear Film & Conjunctiva:
  • Altered tear film (↓ lysozyme, ↑ mucin) → dry eye symptoms (keratoconjunctivitis sicca).
  • Conjunctival vasodilation.
• Other Physiological Changes:
  • Mild ptosis (fluid retention).
  • Chloasma (pigmentary changes on eyelids/periorbital skin).
  • Krukenberg spindles may become more prominent (benign).
  • Transient ↓ accommodative amplitude (rare).

⭐ A transient myopic shift and contact lens intolerance are common due to corneal edema and changes in corneal curvature.

📌 Mnemonic: PERKS of Pregnancy Eyes

• Ptosis (mild)
• Edema (corneal) → Refractive changes
• Refractive shift (myopia)
• Krukenberg spindles
• Sicca (dry eyes) / Sensitivity to contact lenses

Pregnancy-Related Eye Changes - Vision Alarms

• Preeclampsia/Eclampsia:

  • Symptoms: Blurred vision, photopsia, scotomas, diplopia.
  • Signs: Hypertensive retinopathy (retinal arteriolar narrowing, hemorrhages, cotton wool spots, exudates), papilledema, serous retinal detachment.
  • ⚠️ Severe: Cortical blindness (occipital ischemia/edema).

• Central Serous Chorioretinopathy (CSCR):

  • Acute ↓ vision, metamorphopsia, micropsia, central scotoma.
  • Typically 3rd trimester/postpartum.

  ⭐ Central Serous Chorioretinopathy (CSCR) is a key cause of acute vision loss in late pregnancy/postpartum, often resolving spontaneously.

• Pituitary Adenoma Enlargement:

  • Pre-existing pituitary adenomas may enlarge.
  • Symptom: Bitemporal hemianopia.
  • Urgent neuro-ophthalmic referral.

• Other Grave Conditions:

  • DIC (Disseminated Intravascular Coagulation): With HELLP/abruption. Ocular: Choroidal infarcts, serous retinal detachment, retinal/vitreous hemorrhages.
  • Uveitis: Variable course. Toxoplasmosis reactivation. Vogt-Koyanagi-Harada (VKH) syndrome may trigger/worsen.
  • Purtscher-like Retinopathy: Rare; associated with pancreatitis, amniotic fluid embolism.

Pregnancy-Related Eye Changes - Old Foes, New Rules

Pregnancy modifies existing eye conditions and their management, presenting unique challenges.

• Diabetic Retinopathy (DR)

  • Can significantly worsen. Risk factors: DM duration, baseline DR severity, poor glycemic control (HbA1c), hypertension, nephropathy.
  • Management:
    • Pre-conception counseling & optimization.
    • Meticulous glycemic control (Target HbA1c < 6.5%).
    • Regular ophthalmic exams:
      • No DR / Mild NPDR: 1st trimester, then as indicated.
      • Moderate NPDR: Each trimester.
      • Severe NPDR / PDR: Monthly or more frequently.
    • Laser photocoagulation: Safe and effective.
    • Anti-VEGF (e.g., Bevacizumab, Ranibizumab): Generally avoided (Category C); consider only for vision-threatening PDR if laser fails/not possible.

  ⭐ Diabetic retinopathy can significantly worsen during pregnancy; meticulous glycemic control and regular ophthalmic exams (at least once per trimester) are paramount.

• Glaucoma

  • IOP often ↓ (↑ progesterone, ↑ uveoscleral outflow, ↑ aqueous outflow facility).
  • Medication safety is key (see flowchart below).
  • Selective Laser Trabeculoplasty (SLT) preferred over incisional surgery if intervention needed.

• Other Conditions

  • Central Serous Chorioretinopathy (CSCR): May occur/worsen, often bilateral; usually self-limiting postpartum.
  • Uveitis: Course is variable. Immunosuppression requires careful selection (e.g., avoid methotrexate).
  • Idiopathic Intracranial Hypertension (IIH): Weight gain can exacerbate. Acetazolamide (Cat C) used cautiously if benefits outweigh risks.
  • Refractive Changes: Transient myopic shift due to corneal edema & ↑ thickness. Delay new spectacle Rx until stable postpartum.
  • Pituitary Adenoma: Pre-existing adenomas may enlarge, causing visual field defects (bitemporal hemianopia).
  • Pre-eclampsia/Eclampsia: Ocular signs include retinal vasospasm, serous retinal detachments, cortical blindness.

High‑Yield Points - ⚡ Biggest Takeaways

• Physiological corneal edema and ↑ thickness cause transient refractive shifts & contact lens intolerance.
• Intraocular pressure (IOP) typically ↓ decreases, often by 10-20%.
• Preeclampsia/Eclampsia can induce severe hypertensive retinopathy, serous retinal detachment, and even cortical blindness.
• Central Serous Chorioretinopathy (CSCR) may develop or worsen, especially in the third trimester.
• Diabetic retinopathy can progress rapidly; regular fundus screening is vital.
• Pituitary adenomas may enlarge, causing bitemporal hemianopia or other visual field defects.