The eye in pregnancy and pre-eclampsia
- Eye and systemic disease
Pregnancy changes the cornea and refraction a little. Visual disturbance in pre-eclampsia is a severe feature and needs urgent assessment.
See it in 3D: Retina · Cornea · Visual cortex
What it is
Pregnancy causes small physiological changes in the eye: the cornea thickens slightly, contact lenses may be less comfortable, refraction can shift and eye pressure falls. More importantly, some diseases appear or worsen. Pre-eclampsia can cause blurred vision, scotomas, serous retinal detachment and cortical blindness. Diabetic retinopathy can progress during pregnancy, and some neuro-ophthalmic conditions (idiopathic intracranial hypertension, pituitary disease) can present.
Eye findings
- Pre-eclampsia: blurred vision, flashing lights and scotomas are severe features.
- Hypertensive retinopathy and serous retinal detachment in pre-eclampsia usually resolve after delivery.
- Cortical blindness from posterior reversible encephalopathy syndrome in pre-eclampsia or eclampsia.
- Diabetic retinopathy can progress during pregnancy.
Screening and follow-up
- Refraction changes in pregnancy are usually temporary: new glasses and refractive surgery are best deferred until after breastfeeding.
- Women with pre-existing diabetes should have a retinal exam before conception or early in pregnancy, and follow-up during it.
- Sudden headache with visual loss and pituitary signs around delivery suggests pituitary apoplexy or postpartum pituitary necrosis.
Next step / Initial management
- Visual symptoms in a pregnant woman after 20 weeks: measure blood pressure and proteinuria and manage as possible severe pre-eclampsia in obstetrics.
- Visual loss with seizures or confusion: emergency (eclampsia, PRES); brain imaging.
- Diabetes before pregnancy: retinal exam in the first trimester and follow-up according to findings.
- Glaucoma drugs and other eye drops during pregnancy: review with ophthalmology.
Test yourself
Think of the answer, then tap the question to see it.
What do new visual symptoms mean in a woman with pre-eclampsia?
A severe feature of pre-eclampsia, needing urgent obstetric assessment and blood pressure control.
What happens to serous retinal detachment of pre-eclampsia after delivery?
It usually resolves without treatment.
Why are new glasses deferred during pregnancy?
Because refraction shifts in pregnancy are often temporary.
Connections
See it in 3D3
The structures of Durgical's 3D anatomy where it is found.
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Ocular Manifestations of Preeclampsia (StatPearls Publishing (NCBI Bookshelf), 2024); Preeclampsia (StatPearls Publishing (NCBI Bookshelf), 2024); Guía de práctica clínica: complicaciones del embarazo, parto o puerperio (Ministerio de Salud y Protección Social de Colombia, 2013).
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Representative model, for educational purposes only.