Pregnancy is a milestone in the physiology of the female body.
Many things change, some with a temporary appearance and others with a permanent presence. In this context, the ocular system is subject to changes and it is important to know whether these are normal and expected.
Changes in the body's hormones and immune system can bring about changes that are predictable and reversible.
For example, increased pigmentation may occur in the area around the eyes and the conjunctivae may appear slightly oedematous. The same can be seen in the corneas making them slightly more convex, resulting in a change in the refractive state. These changes should be monitored without refractive correction as most of the time the condition returns to the previous state within a few weeks after childbirth. Intraocular pressure also fluctuates with a usual drop after the 20th week of gestation and recovery after 2 months after delivery. The decrease in visual field that sometimes occurs is also noteworthy. The mechanism of this phenomenon is as yet unknown but requires attention if it is accompanied by symptoms.
In any case, however, monitoring is important to avoid unpleasant situations. Let us not forget that a multitude of pathological conditions can be hidden behind a visual field impairment.
When the mother has pre-existing pathological conditions then it is likely that these will destabilize and worsen.
The most important conditions at risk of worsening include diabetic retinopathy. If the condition is in an unproductive stage then follow-up by an ophthalmologist is necessary every three months. However, if it is in a productive stage then monitoring should be monthly.
The occurrence of macular edema also requires monitoring but most of the time it seems to subside after childbirth in combination with proteinuria and hypertension.
Among other conditions that may show deregulation we should highlight adenomas, toxoplasmosis, but also autoimmune diseases such as Grave's disease. It is useful to remember that migraines make their presence strongly felt many times during pregnancy, as these patients often present themselves to ophthalmological examiners fearing an eye disease as the cause of their headaches.
In contrast to the deterioration, some conditions show improvement during pregnancy, as the body seems to mobilise its defences in favour of the new life that develops in utero. Thus, even cases of multiple sclerosis show stabilisation or even improvement during pregnancy.
In addition to the deterioration of pre-existing conditions, new eye problems may occur during these 9 months. Retinopathy from hypertension and severe eclampsia can cause serious problems, while optic neuropathies and detachments are not absent in rare cases.
Finally, we should also mention the use of medications that may be taken for eye problems during pregnancy. Although many drugs have unknown effects on the fetus or static low, it is advisable that any medication be given with caution and sparingly. Increased caution is needed both during pregnancy since some substances are absorbed and cross the placenta, and during the period of breastfeeding because components of the drugs may pass easily into breast milk.
In general, local anaesthetics, steroids and reducers should be administered with caution, and only if deemed necessary, mydriatics for occasional use, beta-blockers with discontinuation before delivery and during breastfeeding and prostaglandins. Antibiotics, antivirals and carbohydrate inhibitors should be avoided.
But don't forget that every situation is different.
