Pregnancy is a very important period in every woman's life. During these nine months, her body undergoes a plethora of changes which result in the occasional creation of various problems related to the normal function of individual systems of her organism. Among those changes, there is a chance for her eyesight to be affected, a fact that compels us to systematically monitor the pregnant woman.

A possible complication of the hormonal changes during pregnancy is the appearance of myopia or the aggravation of already existent myopia. It is also possible to see a transient change in the adjustment of focus. These problems are usually not permanent and eyesight is restored to its natural state after labor.

If we consider that changes in eyesight may indicate other health problems, an ophthalmological examination during pregnancy is a reasonable and necessary procedure. Most future mothers, however, do not include it in the prenatal examinations, usually due to the myth that they are not allowed to use eye drops that dilate the pupil. An examination with pupil dilation is not only a safe procedure, but in some cases it is the best preventive action.

Possible changes in the eye during pregnancy

1) Cornea : Cornea is the transparent membrane in the anterior segment of the eye. Due to hormonal changes, small changes in its curvature and thickness (edema) may occur, causing an intolerance to contact lenses. Furthermore, the use of contact lenses becomes harder due to xerophthalmia caused by reduced tear production. Xerophthalmia usually causes blurry vision and its symptoms may decrease with the use of artificial tears. In addition, the use of contact lenses during pregnancy may pose some risks. The changes that occur naturally in the cornea, in its decreased sensitivity, may make putting on contact lenses difficult and hide a potential infection or some minor injury in places where it is not easy to detect. After birth and lactation, these symptoms subside completely and most women can continue using contact lenses.

2)Visual acuity: Some changes in refraction are possible and a change in glasses may be needed, if it is considered necessary. Changes in refraction are caused by hormonal changes and they are usually reversed, that is why we usually avoid changing glasses. We should mention, however, that blurry vision may occur because of gestational diabetes and for this reason, the physician should be informed immediately about any changes in vision.

3) Photophobia: Headaches and migraines due to hormonal changes may cause great sensitivity to light.

4) Visual Fields: Some cases of change in visual fields in pregnant women have been reported, like partial loss of visual field temporally or magnification of the blind spot, but all these changes are completely reversible and require closer inspection.

5) Pre-eclampsia – Eclampsia: If women that never had high blood pressure suddenly present hypertension, then this is an immediate diagnosis of pre-eclampsia. It appears in about 5% of women and usually after the 20th week of gestation. If hypertension is accompanied by shivers, then it is called eclampsia. The most common symptom is blurry vision that might also be accompanied by headaches, photopsias and diplopia. 10% of women with eclampsia may present edema in the retina, serous detachment and acute ischemic optic neuritis. All these conditions are reversible 1 to 2 weeks after reducing blood pressure or after labor.

6) Central serous retinopathy: It has been reported during pregnancy, mainly in the third trimester. It is reversed automatically and rapidly the first few months after birth.

7) High myopia: All women with medium to high myopia are worried about the consequences on their eyes of a difficult or even a normal labor, that's why they resort to c-section. For years, however, research has shown that this is a myth. Statistics in groups of women with -4.5 to -15.0 diopters, even those with pre-existing myopic damage of the fundus, tears or detachments that were restored with laser or surgically, presented no deterioration or reappearance of these problems after natural birth.

Pathologies that exist before pregnancy and can cause changes in eyesight

1) Diabetic retinopathy: Pregnancy may have negative effects on pre-existing diabetic retinopathy. Its deterioration depends on other factors, such as the severity of the condition before pregnancy, the duration of the disease and if it coexists with high glycated hemoglobin and hypertension. The percentage of women with diabetes that hadn't been diagnosed with retinopathy and it appears during pregnancy is about 10%, but only 0.2% presents degenerative symptoms which, in both cases, are reversed after birth. Depending on the severity and the type of retinopathy, an ophthalmological examination with ophthalmoscopy is necessary in regular intervals.

2) Hypertension: Monitoring blood pressure during the entire pregnancy is necessary, since, in several cases, it has been observed to rise. High blood pressure is accompanied by blurry vision and a sensation that we see bright spots or deformed objects in our visual field. When arterial pressure is not controlled, it may cause damage to the vessels, as well as make other conditions worse.

3) Glaucoma: Some cases, where the intraocular pressure has been reduced and the condition has improved, have been reported, but these observations require further evidence, since all changes during pregnancy are reversible.

4) PURTSCHER retinopathy: he symptoms are decrease in visual acuity, floaters (black spots) and hemorrhage in the back of the eye. All changes in vision subside after several weeks and no treatment is needed.

5) Pituitary adenoma: The adenoma may increase in size, causing changes in our visual field (usually temporally) or headaches and a decrease in visual acuity. A possible cause of the increase of the pituitary adenoma is pituitary apoplexy, which can endanger the person. Women whose adenoma tends to increase and also have headaches, should do an MRI and if this shows subarachnoid hemorrhage, then it is advisable to prefer a c-section. These adenomas reduce in size after birth and leave no eye problems behind.

Symptoms that require an immediate visit to the ophthalmologist

All women that, during pregnancy, have headaches, blurry vision and changes in their visual field should do an ophthalmoscopy and a visual field test with their ophthalmologist.

Refractive surgeries

Refractive surgeries (myopia, hyperopia and astigmatism correction with laser) should be avoided during pregnancy and lactation. The main reason is changes in the cornea, due to hormonal changes, which renders the results impossible to predict. After lactation, when the cornea returns to its natural state, the lacrimal layer is restored, along with any other ophthalmological problem may have appeared, then such a procedure can be scheduled. In case there has been a surgery before pregnancy, there is no risk for the pregnant woman to have natural labor, since all changes, as in the previous case, subside after lactation.

Eye drops use

1)Medication against glaucoma and especially beta blockers should be used in the smallest possible dosage during the first trimester and be completely stopped 2 or 3 days before labor. Local and systemic carbonic anhydrase inhibitors are not recommended during pregnancy and lactation.

2) Eye drops that are used for pupil miosis and dilation, as well as local anesthetics that are used during eye exams are completely safe.

3)Local steroids and antibiotics like erythromycin and quinolones are not recommended.

4) Systemic antibiotics should be avoided during pregnancy and especially during lactation.

The ophthalmological examination should be part of prenatal examinations, not only because it is a very safe process for the future mother and the embryo, but, considering that changes in eyesight warn about other more serious conditions during pregnancy, it may constitute the first step of prevention.

Remember:our ophthalmologist is the best source for responsible answers on issues related to your eyes and their health. Under no circumstances is information taken from our website intended to replace him. Seek your doctor for complete information.