Pregnancy and Ocular Health

Pregnancy may be full of pleasant and unexpected surprises, and each pregnancy has its own unique challenges. Here are some ways pregnancy may affect the eyes and visual system.

1) Melasma is a skin hyperpigmentation most found around the eyes and cheeks but may also be located on the forehead, bridge of the nose, and upper lip area. As estrogen, progesterone, and melanocyte-stimulating hormone increase during pregnancy, they are responsible for these brown-grey patches. Once hormone levels return to baseline post-delivery, the melasma patches typically fade (within a few months). If the skin pigmentation does not return to normal, several treatments are available to reduce the appearance of these dark spots.

2) Dry Eye Syndrome, already more common in women than men, is another change that may occur or worsen during pregnancy. With the downregulation of androgen receptors and its dampening by elevated estrogen and progesterone, normal production and secretion of tear film components (i.e. water, proteins, and IgA) on the ocular surface are disrupted, leading to tear film instability. Additionally, dehydration due to nausea, vomiting, and medications to treat these symptoms can further contribute to dry eye symptoms. If significant, these symptoms can be managed by a combination of at-home and office-based treatments.

(Side note: Certain pharmaceuticals for ocular surface disease such as Xiidra and Cyclosporine (Restasis and Cequa) are contraindicated during pregnancy.)

3) Blepharoptosis may impact one or both upper eyelids due to dysfunction of the eyelid muscles. This occurs due to higher levels of estrogen causing increased water retention, leading to mechanical ptosis. This commonly resolves during the postpartum period. There is currently an FDA approved eye drop (called Upneeq) that may be prescribed for acquired blepharoptosis.

4) Changes in Vision may occur since the cornea undergoes biomechanical changes during pregnancy, which leads to a change in the refractive index of the cornea. These changes are typically temporary and return to baseline several months into the postpartum period.

5) Intraocular Pressure is typically reduced by about 10% during pregnancy, which may benefit women with ocular hypertension or glaucoma.

6) Retinal Vascular Occlusions are rare in women without pre-existing cardiovascular risk factors, however, pregnancy puts women in a hypercoagulable state, and thus more susceptible to retinal vein and artery occlusions during pregnancy. We advised to have the retina evaluated at least once yearly to rule out any symptomatic or asymptomatic retina-related complications. This may be performed WITHOUT dilation using the Optos/Optomap.

(Side note: This hypercoagulable state is a physiological adaptation to pregnancy to prevent postpartum hemorrhage.)

If you and your partner are planning to get pregnant or are expecting, we wish you the best of luck and we are here to serve your eye care needs.