There’s one patient sitting before you, but two lives in the balance over the 40-week course of a pregnancy. During this special time in a woman’s life, her body adapts to carrying a baby. Changes, expected and unexpected, may occur to the eyes. While most of these changes are normal, some may be harmful and very occasionally sight-threatening if left untreated. 

Common changes in a pregnant woman’s body are related to fluctuations in hormones, blood circulation and metabolism. Although most ocular changes are transient and rarely problematic, when a pregnant patient presents with eye issues, optometrists need to know how to manage them.

Physiological changes caused by variations in the hormonal profile and metabolism may include melasma (changes to skin pigmentation), refractive changes as a result of fluid retention, mild ptosis, and increased corneal thickness. Other more unusual changes may affect the intraocular pressure, retina, choroid and visual field, as well as dry eyes experienced as a gritty feeling, and subconjunctival haemorrhage with symptoms of redness and foreign-body sensation. Obstetric complications that impact the eyes typically include pre-eclampsia, central serous chorioretinopathy, retinal artery or vein occlusions, and disseminated intravascular coagulation (Morya et al, 2020 ). 

Other concerns are related to pre-existing disease such as diabetes with the manifestation of diabetic retinopathy, Graves’ disease (resulting from thyroid hormone abnormalities), and idiopathic intracranial hypertension. Some inflammatory conditions may also change during pregnancy and affect the eyes (Morya et al, 2020 ).