Pregnancy and Your Eyes

Some of you may have noticed I haven't been posting as much as I normally do.  Those of you who have seen me in person lately know that's because I'm pregnant!  Actually, now, 37 weeks pregnant and the older I get, each pregnancy gets a little harder.  Though I have gained the least amount of weight of all my pregnancies, I'm still tired and that has left little room for blogging, after work, taking care of two kids and managing our practice.  However, it did remind me that most women are unaware of how pregnancy can actually affect their eyes, so I thought the topic did deserve a post.Pregnancy is obviously characterized by 40 weeks of hormones from your placenta which now affect the rest of your body.  These hormones can cause physiologic and pathologic changes in Mom and baby.  Also, as a pregnant woman, certain medications are contraindicated if you do develop an eye condition and I wanted to review some of the more common ones.Common Eye Conditions:1.  Viral conjunctivitis, or pink eye.  This is characterized by tearing, redness and discharge.  It often spreads from one eye to the other.  You should wash your hands frequently and it is highly contagious the first 5 days of infection. Supportive measures such as cold compresses and artificial tears are the best.  Antibiotic drops are useless against viruses, so no need to take them.2.  Allergic conjunctivitis - this one drives me crazy, especially in Hawaii during mango season.  You'll get the same red, watery eyes, but also accompanied by itching and sneezing.  Unfortunately, it's not recommended to use allergy drops such as Patanol, Pataday or Lastacaft during pregnancy.  So, supportive measures such as cold compresses and artificial tears are the best option during pregnancy.3.  Dry eyes -Many women experience dry eyes pregnancy due to the hormonal changes.  Symptoms include light sensitivity, feeling like there's sand in the eyes and even tearing.Tips

• Take frequent breaks when reading
• Use preservative free artificial tears (sensing the theme here? artificial tears are GOOD during pregnancy!).  And, remember - Visine is NOT an artificial tear!

4.  Change in glasses and contact lenses prescription.You may notice that you don't seem to be seeing as well with your current glasses or contact lens prescription when pregnant.  Everything becomes fluid filled when you're pregnant, even your eye structures.  This fluid changes your glasses and contact lens prescription.  Women complain "I can't see at night".  Pregnancy can also cause more nearsightedness (myopia) and astigmatism which is temporary.  I always advise pregnant patients not to change their prescriptions when pregnant, because it may not be accurate.  Wait at least few weeks post-partum before getting a new prescription.  If you are nursing, I would wait around 6 months (until you are no longer exclusively breast feeding) to get your new prescription for the highest accuracy.5.  NO LASIK!!This goes hand in hand with the recommendation that laser vision correction is NOT recommended during pregnancy or immediately post-partum.  If your prescription is changing, then your doctor cannot be sure of the calculations necessary to give you a good surgical outcome.  Also, the mild sedatives which are given before LASIK and the steroid drops given post-operatively are not allowed during pregnancy.    There are also abnormal eye problems that can occur during pregnancy that you should 'watch' out for (i know that was a weak one!).

• High blood pressure
• Retinal problems
• Blood vessel clots
• Worsening of diabetes
• Worsening of tumors

1.  Eclampsia - This is very severe high blood pressure after the 20th week of gestation.It usually occurs with your first child and causes swelling in your legs and problems with kidneys.  It can cause seizures, headaches, stomach pain andvominting as well as vision abnormalities.  This is why your OB will always ask you about headaches or blurry vision.  You might see lightning flashes, blacking out of part of your vision, double vision or it just might be blurry.  Let your OB know right away if you experience any of the above symptoms.  Typically the eyes improve when the medical condition is treated and usually the baby must be delivered to stop eclampsia.2.  GlaucomaSome patients have glaucoma and then later become pregnant.  Most of the glaucoma drops are contraindicated in pregnancy because they can induce preterm labor and decrease the baby's heart rate.  If you have to use drops, then practice punctal occlusion.  That's when you place the drops in the eye and then hold pressure at the inner corner to minimize the systemic absorption of the drop.        3.  Gestational diabetesThis is the one I'm blessed with.  I didn't have it for my first two boys, but now that I'm over 35 years old, my risk increased and I was diagnosed with diabetes.  It has nothing to do with weight gain during pregnancy (I've only gained 14 pounds during the entire 37 weeks of pregnancy) or fitness level.  Most people are really surprised to learn that I have gestational diabetes.  Gestational diabetes is when your blood sugar levels become elevated during pregnancy in women who have never had diabetes before. Gestational diabetes starts when the mother's body is not able to make and use all the insulin it needs during pregnancy. If you have gestational diabetes, you should see your ophthalmologist every trimester to assess for bleeding in the retina.  However, your risk for developing retinopathy is much lower if you were diagnosed with gestational diabetes than if you had a diagnosis of diabetes prior to getting pregnant.  If you had diabetes (Type I or Type 2) before becoming pregnant, than your risk of bleeding in your eyes is higher during pregnancy.   However, the good news is that most long term studies have shown that progression of retinopathy reverses after delivery and that there are no long term changes.4.  Blood clots in your eyesAs you advance in pregnancy, the blood becomes more viscous and thick.  Clots can form in your legs, lungs and even eyes.  Sudden, profound, painless vision loss must be reported immediately to your OB and ophthalmologist because this could be a "mini-stroke" in your eye or artery occlusion.5. Central serous chorioretinopathyThis is relatively rare, but I just saw a patient who was in her first trimester who had central serous chorioretinopathy.  Basically, this is a blister of fluid which builds up in the center most part of your retina, called the macula.  Usually these occur in Type A personality (you know, OCD, stressed out, perfectionistic type ) males in their 30's and 40's.  It's induced by stress, hormones, and steroids.  However, those same hormones in pregnancy can cause CSCR in pregnancy.  Patients experience blurry vision, sudden onset of dim vision, waviness in your vision, decreased color vision, and the feeling that things look smaller in one eye than another.  Definitely see your opthhalmologist for any changes in your vision during pregnancy.          Please forgive any typos - I am posting this from the hospital bed where I am in labor!  Finishing this post is helping distract me from the pain of contractions!!