OCULAR CHANGES IN PREGNANCY
Have you noticed that sometimes as the baby in your tommy is growing, your vision is suddenly getting blurry or you may develop some other eye problems, which were not present before the pregnancy?
Well, you have to first, remember that in pregnancy, there are series of interplay of hormones which affects the physiology of the woman’s body and of course the eye, as well.
However, many of these changes in normal pregnancy are transient in nature, occasionally though, they may be linger even after pregnancy or even preexisting eye conditions can worsen or get better in pregnancy!
SOME TRANSIENT EYE CHANGES IN PREGNANCY
- Darkening of the eyelid areas – This is referred to as melasma or chloasma (or simply put… ‘the mask of pregnancy’) which result from increased activity of the melanocyte of the skin as they produce more melanin. This increase in pigmentation is associated with increased estrogen and progesterone levels. However, this is only for a while, it vanishes almost completely by postpartum.
- Peppery eyes – This is due to changes in normal constituent of tears of the eyes that serves as lubricant, thereby making the pregnant mother’s eye drier and sometimes, feeling of sandy sensation in the eye.
- Blurry vision – You may notice that your current prescription glasses, no longer works; this is due to changes in the thickness of the cornea and the lens, and resultant fluid accumulation within these tissues. So pregnancy may not be an ideal time for laser eye surgery or fitting in a new contact lens. Water retention and the distorted vision may even linger up till lactation but will in most cases, vanish with time.
- Near – sightedness – Some women realize that in pregnancy, they are a bit more nearsighted than at ordinary times.
- Seeing Floaters – Some pregnant women complain of seeing tiny strands, spots moving slowly before the eyes as if they are floating. This may happen in early pregnancy but is mostly noticed as pregnancy advances, predominantly in the third trimester of the pregnancy. During this stage of pregnancy, the hyaloid artery regresses to provide nutrients to the developing lens in the growing fetus, but it may not regress completely, then the remnants are thus perceived as floaters. However, it is wise to complain to your eye specialist, to rule out any serious condition.
- Ptosis – this refers to the drooping of eyelids. It is also due to fluid retention and hormonal. It requires no treatment.
“The eyes are the window to the soul.” –English proverb
Occasionally, eye findings are pointers to underlying systemic diseases, facilitating diagnosis.
Many systemic diseases have ocular manifestations. Vision changes such as increased light sensitivity, seeing flashing lights, floaters or loss of vision can be indicators of the following potentially serious health issues in pregnancy:
- Preeclampsia – Preeclampsia is defined as the new onset of hypertension and proteinuria during the second half of pregnancy. Visual disturbances, such as double vision and increased sensitivity to light are seen in 25% of women with severe pre-eclampsia and in 50% of women with eclampsia.
- Gestational Diabetes – This is a transient form of diabetes that affects pregnant women. The high blood sugar levels can cause damage to the small blood vessels that supply the retina.
- High Blood Pressure – Increase in blood pressure during pregnancy can cause blurred vision and seeing of spots. It can worsen, causing retinal detachment.
So whenever, you notice changes in your vision during pregnancy, see your doctor, so that proper examinations can be conducted.
GLAUCOMA IN PREGNANCY
It does seem like good news that pregnancy has beneficial effects on glaucoma patients as the disease may not progress during this period.
In pregnancy, intraocular pressure tends to reduce and this happens to be the therapeutic goal in glaucoma.
However, women being treated for glaucoma should inform their eye doctor right away if they are pregnant or intend to become pregnant.
While many glaucoma medications are safe to take during pregnancy, certain glaucoma medications such as carbonic anhydrase inhibitors (acetazolamide, methazolamide, brinzolamide) can be harmful to the developing baby, thus dosage adjustment or change in prescription may be required.
Beta adrenoceptor blockers such as atenolol, nadolol, labetalol, betaxolol and carteolol should be avoided or used in the lowest possible dosage in the first trimester of pregnancy. And they should be discontinued 2–3 days before delivery to avoid beta-blockade in the newborn characterized by difficulty in breathing and low blood sugar.
Eye Diseases That May Worsen In Pregnancy
- Diabetic Retinopathy – This is a diabetes that affect the eyes. This condition deteriorates in pregnancy if the woman has poorly controlled blood sugar during pregnancy. In other words, if a woman has mild retinopathy, it may progress to a much more severe form during pregnancy. However, if the blood sugar levels are well-controlled, you can be free from this complication.
If you diabetic, see an Ophthalmologist periodically during pregnancy and postpartum.
- Thyroid eye disease (TED) –TED is an autoimmune condition in which immune cells attack the thyroid gland and in response the gland secretes excess amount of thyroid hormone, causing enlargement of the thyroid gland. The markedly high levels of thyroid hormone produced plunges the biologic system into a hypermetabolic state, often characterized by increase in heartbeat, palpitations, fatigue, profuse sweating, heat intolerance, high blood pressure, irritability, weight loss and loss of hair.
With the attack of the immune system on ocular tissues, eye muscles become inflamed, causing ‘staring’ or ‘bulging’ eyes and double vision, eventually.
- Sunness JS and Santos A. (2001). Pregnancy and the Mother’s eye. In: Duane’s Clinical Ophthalmology on CD-ROM. Philadelphia: Lippincott Williams & Wilkins.
- Sharma S, Wuntakal R, Anand A, Sharma TK and Downey G. (2100). Pregnancy and the eye. Online Wiley Library. The Obstetrician & Gynaecologist Volume 8, Issue 3, 24 JAN 2011.
- Khawla AS (2013). The eye and visual system in the preeclampsia/eclampsia syndrome: What to expect? Saudi J Ophthalmol. 2013 Jan; 27(1): 51–53. doi: 1016/j.sjopt.2012.04.003
- Auger N, Fraser WD, Paradis G, Healy-Profitós J, Hsieh A, Rhéaume MA. (2017). Preeclampsia and Long-term Risk of Maternal Retinal Disorders. Obstet Gynecol. 2017 Jan; 129(1):42-49. doi: 10.1097/AOG.0000000000001758
Article Contributed by a Consultant Ophthalmologist, Henry C. Ogbuehi (MBBS, FMC Oph., FWACS)