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Pregnancy and the eye

As a retina specialist, I examine a lot of pregnant women who have diabetes. What am I looking for during those exams? Evidence of diabetic retinopathy — bleeding, cholesterol leakage, swelling of the macula and new blood vessel formation. Worsening of diabetic retinopathy is one of the many potential changes to the eye during pregnancy.

While diabetic changes to the eye can worsen during pregnancy, if you suffer from uveitis, it usually gets better during pregnancy with fewer flare ups.

Skin Changes

One of the changes that can occur during pregnancy is cholasma, a hormone-mediated increase in pigmentation. This can affect the skin around the eyes and on the cheeks. Vascular formations called spider angiomas can also pop up on the face. Fortunately, both of these conditions spontaneously resolve once you deliver.

Blurry Vision

There are several things can happen during pregnancy to can cause blurry vision. Pregnancy is associated with water retention and this can result in decreased corneal sensitivity and increases in corneal thickness and curvature. The result is a temporary change in your glasses prescription — so don’t get LASIK or PRK during pregnancy because the measurements will be off.

An increase in corneal curvature can also result in contact lens intolerance and poor fit of the lens. Dry eye syndrome may also develop because of decreased tear production.

Eye pressure (IOP) also decreases during pregnancy (just like blood pressure does). Principally, this occurs during the second half of pregnancy and will return to normal after delivery.

A droopy eye (ptosis) can also develop on one side during pregnancy–due to effects of increased fluid and hormones on the muscle that elevates the eyelid.

Preeclampsia, Eclampsia and HELLP Syndrome

If you are unfortunate enough to develop preeclampsia or eclampsia during pregnancy, there is a 20-50% chance of having visual symptoms (blurry vision, flashing lights, blind spots, double vision or total vision loss). These are a result of retinal swelling, bleeding and leakage of cholesterol from blood vessels. Rarely, a patient could develop artery or vein occlusions or optic disc swelling or ischemia.

There is a 1% chance of fluid leaking under the retina (exudative retinal detachment) in preeclampsia and 10% in eclampsia, which would also result in blurry vision. HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) patients are 7 times more likely to have fluid under the retina are due to arteriolar spasm and ischemia in the choroid.

While exudative retinal detachment is more common during the first pregnancy and with C-section, the good news is that it usually resolves spontaneously after delivery and the associated blurry vision should also resolve in a few weeks.

Cortical blindness (vision loss due to edema in the occipital lobe of the brain) can occur in 15% of women with preeclampsia or eclampsia, but it is also reversible.

Central Serous Chorioretinopathy (CSC)

CSC has been associated with late pregnancy due to increased cortisol levels and results in accumulation of fluid under the retina, usually in one eye. Symptoms include distortion and blurry vision. This condition also usually resolves after delivery of the baby.

A lot can happen to your eye and visual symptom during pregnancy and around the time of delivery. If you develop any visual symptoms, please don’t hesitate to get your eyes examined by an ophthalmologist.


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