Eyes in Pregnancy: What Can Happen?

Today’s topic might be something that many of us haven’t spent a lot of time thinking about - what kind of changes can occur within our eyes during pregnancy? If you have a pre-existing condition, either physical or specifically ocular, are the eyes particularly susceptible to damage during pregnancy and should specific precautions be taken? Could your eyesight worsen? Or can it improve? What effects does breastfeeding have?

Ophthalmologist Dr. Amaka Eneh joins Dr. Alicia to answer the above questions and much more on today’s episode! Today’s episode may also encourage you to optimize your preconception health. Luckily, we've put together a clear, easy to read guide to help ensure your physical and mental health are in good shape as you begin your journey through motherhood. Download our Preparing for Pregnancy guide here!

What changes can occur?

Pregnancy is a transformative period marked by numerous physiological alterations - and the eyes are no exception! While the primary demographic in an eye doctor's clinic traditionally veers away from the pregnancy age, advancements in reproductive technology have ushered in an era where older patients may navigate both pregnancy and eye health concerns.

Contrary to the perceived rarity of eye conditions in younger individuals, congenital and juvenile eye anomalies coexist with pregnancy, at times necessitating a nuanced approach to eye care.

Beyond the eye itself, noticeable changes can unfold around the eyes during pregnancy. The skin around the eyes undergoes shifts in pigmentation, and alterations in blood vessels, particularly those around the nose, become apparent. Reports of eyelid drooping have been known, though rare.

How might pregnancy affect my prescription?

Hydration and swelling in particular will impact things. If ligaments supporting the eye start to stretch you can imagine that the “hammock” that supports the eye would sag more. Sometimes minuscule changes of the position of the lens inside the eye can spread to big changes to your glasses prescription.

Surprisingly, being pregnant can affect how we correct our vision. It was generally thought that nearsightedness (myopia) gets worse during pregnancy. But a big study in Spain looking at over 10 000 women showed that in some pregnant cases, myopia improves. Your nearsightedness improves during pregnancy, meaning your vision gets better!

What about labor & delivery?

During vaginal labor, there are occasional instances of retinal bleeding observed in some women, especially those with a history of retinal detachments. A recent study explored the question of whether people with such histories should opt for Cesarean Sections to mitigate potential risks, but the prevailing consensus was that prioritizing the needs of the pregnant person and baby are most important, and any issues that arise can be dealt with after the fact, as needed. 

The decision to encourage or discourage you from pushing would involve a nuanced consideration of your health history, and does not necessarily mean avoiding vaginal delivery entirely. There are many techniques that can minimize pushing effort, such as epidurals, and allow the body more time to naturally progress post-full dilation. While the likelihood of encountering retinal problems during labor is relatively low, people with pre-existing eye concerns are advised to consult their ophthalmologists about the safety of pushing during labor. 

What about preeclampsia, or other inflammatory conditions?

Preeclampsia, an elevated blood pressure during pregnancy, can have effects on eye health. Pregnant people will often talk about having spots or changes in their vision when their blood pressure is quite high, though if you are in that state a visit to a hospital rather than an ophthalmologist is needed, to manage the blood pressure.

With other non-infectious inflammatory conditions, such multiple sclerosis and neuromyelitis optica (NMO), it is sometimes reported that symptoms improve during pregnancy. This is possibly because our whole immune system is suppressed, and therefore any auto-immune issues are lessened because the whole immune system is “less active,” so to speak.

What about diabetes?

Whether you have Type 1 or Type 2 diabetes, ophthalmologists generally approach treatment and eye examinations similarly. Most people with diabetes fortunately exhibit minimal changes in the back of their eyes. Ophthalmologists look for tiny bleeds, alterations in blood vessel shape, and potential macular swelling. In severe cases, diabetes may prompt the development of extra blood vessels, termed neovascularization, which can lead to complications.

In cases where an injection is necessary to treat the neovascularization of the eye, research supports that the treatment is safe during pregnancy. The most important thing to know is that communication with your healthcare provider is key! Please inform them if you are planning to become, or are pregnant, so they can monitor specific areas or provide more frequent check-ups, especially if diabetic retinopathy is present.

What if I already have glaucoma? 

Glaucoma, a condition affecting the optic nerve, often leads to peripheral vision loss, remaining asymptomatic until advanced stages. The primary approach to treatment is pressure control, as damage to the optic nerve is irreversible.

Contrary to common belief, glaucoma isn't exclusively linked to high eye pressure; it can occur even with technically low pressure. Treatment involves eye drops, laser therapy, or surgery. Although typically associated with an older demographic, glaucoma can manifest at any age, including during pregnancy.

For pregnant individuals with glaucoma, limited research on medication safety exists, making case reports and small cohorts the main data sources. Adjusting eye drops during pregnancy may be considered, and a technique involving tear duct blockage minimizes systemic absorption. Tune into our reel for instructions on how to block your tear duct so the medication enters your eye, but not your entire body/bloodstream! 

Continuing glaucoma treatment during pregnancy is often feasible, with potential flexibility in the number of drops used, guided by healthcare providers. Laser therapy, an alternative to eye drops (not to be confused with LASIK!), is a viable option.

While glaucoma surgery during pregnancy is rare, it's not impossible and requires a thorough risk-benefit discussion involving anesthesiologists and additional support. Again early pregnancy disclosure facilitates informed decisions about treatment adjustments, ensuring optimal eye health for both mother and baby.

In the case of any new visual changes for which the cause may not be obvious, often times the problem can be resolved. Try not to panic. But do consider getting a check up if you’re concerned, because early prevention or treatment is usually most effective. Make sure to tune into the episode for even more knowledge about eyes in pregnancy - like what part does breastfeeding play in it all!?

Looking for more? Check out our Pregnancy to Parenthood Online Prenatal Masterclass, taking you from anxious and overwhelmed to confident during your childbirth experience!