eye manifestations during pregnancy

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Eye manifestations during pregnancy

ByDr Mohamed Abusharifa, MD

Ophthalmic surgeonTulkarem - Palestine

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To highlight those the eye problems, which are related with pregnancy,

without interfering into treatment modalities

TARGET

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Ocular changes that occur in pregnancy are usually TRNSIENTTRNSIENT in nature, but occasionally there may be PERMANENT PERMANENT disorders

Eye manifestations during pregnancy

Courtesy of: Sunness JS. The pregnant woman’s eye. Surv of Ophthalmology 1988;32:219-38

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PLAN1.1. NEURO-OPHTHALMOLOGICAL NEURO-OPHTHALMOLOGICAL

changes changes appearing in pregnancy

2. The effects of pregnancy on PRE-EXISTINGPRE-EXISTING ocular disorders

3. Ocular disorders associated with PREGNANCY-RELATED diseasesPREGNANCY-RELATED diseases

4. Eye changes developing DURING PREGNANCYDURING PREGNANCY

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BUT BEFOREBEFORE proceeding into presentation

please pay attentionpay attention to the following

5 slides :

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nausea + severe vomiting + nausea + severe vomiting + severe headachesevere headache + + intracranial intracranial

disordersdisorders in a pregnant in a pregnant

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Newborn with hydrocephalus due to congenital toxoplasmosis

(From Dubey JP, and Beattie CP. Toxoplasmosis of animals and Man. CRC Press, Baca Raton, Florida, 52,

1988).

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Normal retinaNormal retina

Courtesy of KANSKI : Clinical Ophthalmology

A toxoplasmosis lesion in the center of retina 3

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Diabetic retinopathy Normal retina


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NO contact lenses during pregnancy

X=

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http://images.google.ps/imgres?imgurl=http://i.ehow.com/images/GlobalPhoto/Articles/4715595/Contact-Lensslideshow-main_Full.jpg&imgrefurl=http://www.ehow.com/video_4398868_wear-one-day-contact-lenses.html&usg=__rpZixQF3pn4I8kCfnLJyEIO-Juk=&h=300&w=400&sz=14&hl=ar&start=4&tbnid=eXq7Py0JcImexM:&tbnh=93&tbnw=124&prev=/images%3Fq%3Dwearing%2Bcontact%2Blenses%26gbv%3D2%26hl%3Dar

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Now presentation starts:

1.1. NEURO-OPHTHALMOLOGICAL NEURO-OPHTHALMOLOGICAL changes changes appearing in pregnancy

2. The effects on PRE-EXISTINGPRE-EXISTING ocular disorders



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NEURO-OPHTHALMOLOGICAL NEURO-OPHTHALMOLOGICAL changes changes appearing in pregnancy

Some of the symptoms which are regarded normalnormal in pregnancy, such as :

nausea & vomitingnausea & vomiting may be signs of intracranial intracranial

disordersdisorders

Courtesy of: T. Walsh, Neuro-Ophthalmology

Clinical Signs & Symptoms

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NEURO-OPHTHALMOLOGICAL NEURO-OPHTHALMOLOGICAL changes changes in pregnancy

Nausea & severe vomitingNausea & severe vomiting should be considered seriously while doing D.DD.D. in a pregnant having:

Visual disturbancesVisual disturbancesPersistent headachePersistent headacheVisual field defectsVisual field defectsOculomotor palsiesOculomotor palsies



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NEURO-OPHTHALMOLOGICAL NEURO-OPHTHALMOLOGICAL cases included in included in DDDD during pregnancy during pregnancy:

Pseudotumor cerebri

(benign intracranial hypertension)Prolactinoma (adenoma of pituitary gland)Venous sinus thrombosis

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Pseudotumor cerebri

(benign intracranial hypertension)Prolactinoma (adenoma of pituitary gland)Venous sinus thrombosis

NEURO-OPHTHALMOLOGICAL casesNEURO-OPHTHALMOLOGICAL cases included in included in DDDD during pregnancy during pregnancy:

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Typical symptoms & findings:Typical symptoms & findings:– Blur vision– Headache– Nausea & severe vomiting– 6th nerve palsy– Edema of optic disc



Pseudotumor cerebriPseudotumor cerebri (benign intracranial hypertension(benign intracranial hypertension))

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nausea + severe vomiting + nausea + severe vomiting + severe headachesevere headache

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LeftLeft Lateral Rectus Muscle palsy due to Left 6th nerve palsy

Courtesy of KANSKI: Clinical Ophthalmology

RightRight Lateral Rectus Muscle palsy due to Righ 6th nerve palsy

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EDEMA OF OPTIC DISCEDEMA OF OPTIC DISC



edema of optic disc Normal optic discNormal optic disc

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• Pseudotumor cerebriPseudotumor cerebri

(benign intracranial hypertension)(benign intracranial hypertension)

• ProlactinomaProlactinoma (adenoma of pituitary gland)(adenoma of pituitary gland)

• Venous sinus thrombosisVenous sinus thrombosis

NEURO-OPHTHALMOLOGICAL casesNEURO-OPHTHALMOLOGICAL cases included in included in DDDD during pregnancy: during pregnancy:

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• Pseudotumor cerebriPseudotumor cerebri

(benign intracranial hypertension)(benign intracranial hypertension)

• ProlactinomaProlactinoma (adenoma of pituitary gland)(adenoma of pituitary gland)

• Venous sinus thrombosisVenous sinus thrombosis


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ProlactinomaProlactinoma

A noncancerous tumor )adenoma( affecting the pituitary gland that causes increase in the production of the hormone prolactin hormone prolactin ((LTHLTH))

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ProlactinomaProlactinomaSymptoms & findings:• Galactorrhea• Amenorrhea• Fatigue• Decreased libido• HeadacheHeadache• Visual disturbances )due to pressurepressure on the opticoptic

nervenerve(• Visual field defects )due to pressurepressure on the opticoptic

chiasmchiasm(

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Pituitary glandPituitary gland

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Pituitary gland Pituitary gland pressing on pressing on optic chiasm from belowoptic chiasm from below

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Optic chiasmOptic chiasm

Courtesy of: Dynamic Human Anatomy Student Version

tip

Optic nerveOptic nerve

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Enlarged sella turcica due to pressure caused by pituitary adenoma

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Pt’s view

normalnormal Visual field Visual field inin Left EyeLeft Eye

Courtesy of D. J. Spalton: Atlas of CLINICAL OPHTHALMOLOGY

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normal visual field in Right EyeRight Eye

Courtesy of D. J. Spalton: Atlas of CLINICAL OPHTHALMOLOGY

Pt’s view

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Asymmetric bitemporal visual field loss due to pressure on the optic chiasm &

optic nerve from below

Courtesy of Visual Fields: Examination & Interpretation Publication of American Academy of Ophthalmology

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Pituitary adenoma )prolactinoma(


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ProlactinomaProlactinoma

It is recommendedrecommended that any pregnant with a knownknown pituitary prolactinoma must

have regular visual field follow-upvisual field follow-up to rule out enlargementenlargement which leads to compression of optic chiasm and causes uncorrected visual field lossuncorrected visual field loss


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• Pseudotumor cerebri

)benign intracranial hypertension(

• Prolactinoma (adenoma of pituitary gland)

• Venous sinus thrombosis

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• Pseudotumor cerebri

)benign intracranial hypertension(

• Prolactinoma

(adenoma of pituitary gland)

• Venous sinus thrombosis

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Venous sinus thrombosisVenous sinus thrombosis

is a form of brain strokebrain stroke that results from thrombosis of the dural venous sinuses

Courtesy of Lanska DJ, Kryscio RL. Risk factors for peripartum & pastpartum stroke& intracranial venous thrombosis. Stroke 2000;31:1274-82

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Venous sinus thrombosisVenous sinus thrombosisIncreased risk of occurrence in :Cesarean delivery

Advanced maternal ageHypertension

Infections


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Venous sinusesVenous sinuses

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Venous sinus thrombosisVenous sinus thrombosisSigns & symptoms:Signs & symptoms: Throbbing headacheThrobbing headache Focal or generalized seizuresseizures ParesisParesis Optic disc edema


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nausea + severe vomiting + nausea + severe vomiting + severe headachesevere headache

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Venous sinus thrombosisVenous sinus thrombosis

thrombusthrombus

Courtesy of Lanska DJ, Kryscio RL. Risk factors for peripartum & pastpartum stroke& intracranial venous

thrombosis. Stroke 2000;31:1274-82

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EDEMA OF OPTIC DISCEDEMA OF OPTIC DISC



edema of optic disc Normal optic discNormal optic disc

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PLAN





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The effects of pregnancy on PRE-EXISTING PRE-EXISTING ocular

disorders

– Diabetic retinopathy– Graves’ disease– Glaucoma– Uveitis

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disorders

– Diabetic retinopathy– Graves’ disease– Glaucoma– Uveitis

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disorders

Diabetic retinopathy

is the most ocular disorder modified by pregnancy

Courtesy of Sheth BP. Does pregnancy accelerate the rate of progression of diabetic retinopathy? Curr Diab Rep 2002;2:327-30

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The effects of pregnancy on PRE-EXISTING PRE-EXISTING ocular disorders

Diabetic retinopathyits progression is affected by :

1. Duration of DM

2. Presence of diabetic retinopathy at conception

3. Sugar control during pregnancyCourtesy of Sheth BP. Does pregnancy accelerate the rate of progression of

diabetic retinopathy? Curr Diab Rep 2002;2:327-30

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disordersDiabetic retinopathy

1. Ophthalmic status should be evaluated before pregnancy

2. Good sugar control throughout pregnancy

3. Eye exam every 3 months

4. Treatment by laser photocoagulation before pregnancy may reduce progression by 50%

Courtesy of Sheth BP. Does pregnancy accelerate the rate of progression of diabetic retinopathy? Curr Diab Rep 2002;2:327-30

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disorders

Diabetic retinopathy Normal retina


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disordersDiabetic retinopathy

laser photocoagulation

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disorders

• Diabetic retinopathy

• Graves’ diseas

• Glaucoma

• Uveitis

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disorders • Diabetic retinopathy

• Graves’ diseas

• Glaucoma

• Uveitis

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disorders

Graves’ disease

Pre-existing hyperthyroidism can be

aggravatedaggravated in pregnancy.

Courtesy of Amino N et al. Aggravation of thyrotoxicosis in early pregnancy and after delivery in Graces’ disease. J Clin Endocr Metab 1982;55:108-12

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disorders

The initial initial onset of Graves’ disease

may occur during pregnancyduring pregnancy

Courtesy of Amino N et al. Aggravation of thyrotoxicosis in early pregnancy and after delivery in Graces’ disease. J Clin Endocr Metab 1982;55:108-12

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disorders


Thyroid ophthalmopathy

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• Graves’ disease

• Glaucoma

• Uveitis

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• Graves’ disease

• Glaucoma

• Uveitis

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Glaucoma (increase in intraocular pressureincrease in intraocular pressure)

Courtesy of F. Newell: Ophthalmology principles & concepts

leads to:optic disk atrophy

loss in visual field

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atrophic glaucomatous optic disk

Courtesy of Kanski: CLINICAL OPHTHALMOLOGY

NORMAL OPTIC DISK

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Courtesy of Kanski: CLINICAL OPHTHALMOLOGY

Progression of glaucomatous visual field lossvisual field loss

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disorders

During pregnancy occurs During pregnancy occurs decreasedecrease in intraocular in intraocular

pressure (pressure (temporary controltemporary control) ) !!!!!!

Courtesy of Johnson SM, Martinez M, Freedman S. Management of glaucoma in pregnancy & lactation. Surv. Ophthalmol 2001;45::449-54

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disorders – Diabetic retinopathy– Graves’ disease– Glaucoma– Uveitis

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disorders – Diabetic retinopathy– Graves’ disease– Glaucoma– Uveitis

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disorders :

A non-infectious inflammation of uvea, which sometimes accompanies inflammations of connective tissue: arthritis, spondyloarthritis ….etc

Courtesy of F. Newell: Ophthalmology principles & concepts

UveitisUveitis

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disorders

During pregnancy also occurs temporary improvement of uveitis !!!temporary improvement of uveitis !!!

Courtesy of Sunness JS, Santos A, Pregnancy & the Mother’s eye: Lippincott Williams & Wilkins;2001

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PLAN





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Ocular disorders associated with PREGNANCY- RELATEDPREGNANCY- RELATED diseases diseases

o Toxoplasmosiso Toxemic retinopathy of pregnancy

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o Toxoplasmosiso Toxemic retinopathy of pregnancy

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Toxoplasmosis Is an infection caused by the

intracellular protozoon )Toxoplasma gondii(, by ingestion of raw orraw or undercooked meatundercooked meat containing oocysts, or by exposure to oocysts in cat fecescat feces

Fabiana Maria Ruiz Lopes - Toxoplasma gondii infection in pregnancy

Brazilian Journal of Infectious Diseases

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It is acquired transplacentallytransplacentally, which may cause:• Abortion• Miscarriage or stillbirth• Chronic chorioretinitis blindnessblindness• Severe jaundice & hepatosplenomegaly• CNS lesions:

– HydrocephalusHydrocephalus– Intracerebral calcificationIntracerebral calcification– Mental retardationMental retardation– convulsionsconvulsions

Neonatal congenital toxoplasmosis

Fabiana Maria Ruiz Lopes - Toxoplasma gondii infection in pregnancy Brazilian Journal of Infectious Diseases

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Girl with hydrocephalus due to

congenital toxoplasmosis.

(From Dubey JP, and Beattie CP. Toxoplasmosis of animals and Man. CRC Press, Baca Raton, Florida, 52,

1988).

Brain calcification in congenital toxoplasmosis

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Normal retinaNormal retinaToxoplasmosis lesion in center Toxoplasmosis lesion in center of retinaof retina


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Suggestion

• The serological research for toxoplasmosis in pregnant women should be mandatory by law, as in some countries: France & Austria,

• Neonatal screening programs for congenital toxoplasmosis should be done routinely as Guthrie test for PKU (phenylketonuria).

Courtesy of Fabiana Maria Ruiz Lopes - Toxoplasma gondii infection in pregnancy Brazilian Journal of Infectious Diseases

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o Toxoplasmosiso Toxemic retinopathy of pregnancyToxemic retinopathy of pregnancy

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o Toxoplasmosiso Toxemic retinopathy of pregnancyToxemic retinopathy of pregnancy

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Toxemic retinopathy of pregnancy Toxemic retinopathy of pregnancy occurs:occurs:

During pre-eclampsiaPremature separation of the placenta

)Abruptio placentae( Retention of dead fetus


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Toxemic retinopathy of pregnancy:Toxemic retinopathy of pregnancy: Cotton wool spotsCotton wool spots Retinal hard exudates Retinal hard exudates Edema of optic discEdema of optic disc Retinal hemorrhagesRetinal hemorrhages Serous chorioretinopathySerous chorioretinopathy


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Toxemic retinopathy of pregnancyToxemic retinopathy of pregnancy

edema of optic discedema of optic disc & & retinal hemorrhagesretinal hemorrhages& & cotton-wool spotscotton-wool spots & & central exudatescentral exudates



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Toxemic retinopathy of pregnancyToxemic retinopathy of pregnancy

Central serous chorioretinopathyCentral serous chorioretinopathy



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PLAN





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Eye changes developing DURING PREGNANCYDURING PREGNANCY

ONON:• LIDSLIDS

• CORNEACORNEA

• TEARS PRODUCTIONTEARS PRODUCTION

• LENS LENS

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ChloasmaChloasma on on LIDSLIDS(Chloasma gravidarum)(Chloasma gravidarum)

((Mask of pregnancyMask of pregnancy))Blotchy brown discoloration Blotchy brown discoloration

around lids, due to around lids, due to pigmentation pigmentation It fades in postpartum period It fades in postpartum period

No treatment needed No treatment needed

Courtesy of Sushma Sharma - Review: Pregnancy and the eye

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Due to fluid retentionDue to fluid retention

This (This (edemaedema) causes: ) causes:

1. MYOPIC change change

2.2. Intolerance to CLIntolerance to CL due to traumatic traumatic effectseffects on corneal surface

Corneal edema Corneal edema onon CORNEACORNEA

Normal corneal thickness

Increased corneal thickness


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Decrease in Decrease in tears productiontears productionin 80% of pregnant womenin 80% of pregnant women

It causes It causes Intolerance to wearing CLIntolerance to wearing CL


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Pregnants are advised to

avoid wearing CL

X=Courtesy of Sushma Sharma - Review: Pregnancy and the eye

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onon lens = lens = increase in lens curvatureincrease in lens curvature

leads to:leads to: Temporary myopiaTemporary myopia

Normal Normal lens lens

curvaturecurvature

Increased Increased lens lens

curvaturecurvature

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conclusion 1. Attention to NAUSEA & VOMITTING when

accompanied by intracranial disorders

2. SEROLOGICAL RESEARCH for toxoplasmosis in pregnant women.

& Neonatal screening for CONGENITAL TOXOPLASMOSIS

3. Good control of SUGAR in diabetic pregnants

4. No CONTACT LENSES during pregnancy

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THANK YOUTHANK YOU

eye manifestations during pregnancy

Documents

pregnancy ocular changes

nerve palsy courtesy

nausea vomiting

pregnant womans eye

eye problems

toxoplasmosis of animals

pregnant having

permanent disorderscourtesy