Clinical Features of the Ophthalmic Status in Pregnant Women

Ophthalmologist consultation has an important role in the examination of pregnant women. In some cases, his conclusion can play a decisive role in choice of delivery method. Obstetricians-gynecologists rely on ophthalmologist opinion for determining the severity of preeclampsia; it affects the treatment tactics and the life of mother and child. Examination of a pregnant woman has a number of characteristics, with regard to them, 3 groups of patients, which can be identified: the first group — Physiological pregnancy
without ophthalmological pathology. The second group: Physiological pregnancy with eye pathology in the anamnesis: myopia, peripheral choriovitreoretinal dystrophy; retinal detachment, vitreous body, vascular membrane, etc. Third group — Pathologically flowing pregnancy with pathology resulting from pregnancy: pre-eclampsia, anemia, diabetes and others pregnant. In physiological pregnancy without ophthalmological pathology, the most common physiological changes are increased pigmentation around the eyes, ptosis, a decrease of conjunctival capillaries, changes of cornea sensitivity and thickness, and, consequently, a change in refraction with a myopic shift, a decrease of tolerance to contact lenses, a decrease intraocular pressure, hemeralopia. It is necessary to differentiate the physiological feature of pregnancy, which include, in particular, the shift of refraction to the myopia, from pathological manifestations such as retinal angiopathy, macular edema, central serous chorioretinopathy and others. An important aspect is the  identification of potentially dangerous conditions of laser retina coagulation no later than 34 weeks of gestation with considering the
possibility of rheumatogenic retinal detachment and dystrophic changes in the delivery. This procedure can allow avoiding operative
delivery in the second group of patients. Timely detection of angiospasm on fundus in patients with pre-eclampsia from the third group, will make the right choice in the tactics of managing a pregnant woman. Carrying out the minimum instillation medication regime, especially in the first trimester of pregnancy, will make it possible to reduce the negative impact of therapy on the mother and child

1. Жангереев А.Т. Роль санитарно-просветительной работы в профилактике кариеса зубов и гигиены полости рта у беременных. Клиническая медицина Казахстана. 2012;2(25):96–100. [Zhangereev A.T. The role of health education in the prevention of denta caries and oral hygiene in pregnant women. Clinical Medicine of Kazakhstan=Klinicheskaya meditsina Kazakhstana. 2012;2(25):96–100. (in Russ.)]

2. Orban N., Maughan E., Bleach N. Pregnancy-induced rhinitis. Rhinology. 2013;51(2):111–9. DOI: 10.4193/Rhino12.045

3. Caparroz F.A., Gregorio L.L., Bongiovanni G., Izu S.C., Kosugi E.M. Braz. J. Rhinitis and Pregnancy: literature review. Otorhinolaryngol. 2016;(1):105–11. DOI: 10.1016/j.bjorl.2015.04.011

4. Gotovac M., Kastelan S., Lukenda A. Eye and pregnancy. Coll. Antropol. 2013;37(1): 189–93.

5. Omoti A.E., Waziri-Erameh J.M., Okeigbemen V.W. A review of the changes in the ophthalmic and visual system in pregnancy. Afr. J. Reprod. Health. 2008;12(3):185–96.

6. Weinreb R.N., Lu A., Key T. Maternal ocular adaptations during pregnancy. Obstetrical and Gynecological Survey. 1987;42:471–483.

7. Mackensen F., Paulus W.E., Max R., Ness T. Ocular Changes During Pregnancy. Dtsch. Arztebl. Int. 2014;111(33–34):567–76. DOI: 10.3238/arztebl.2014.0567

8. Sharma S.R.W., Sharma T., Downey G. Refractive issues in pregnancy. Aust. N. Z. J. Obstet. Gynaecol. 2006;46:186–188.

9. Sharma S., Wuntakal R., Anand A., Sharma T.K., Downey G. Pregnancy and the eye. The Obstetrician & Gynaecologist. 2006;8:141–146.

10. Sunness J.S. The pregnant woman’s eye. Surv. Ophthalmol. 1988;32:219–38.

11. Ekpenyong B.N., Aruotu N.A., Uzodike E.B., Njoku C.G. Clinical Investigations and Management of Refractive Changes in Pregnancy: A Case Report. Afr. J. Reprod Health. 2015;19(4):107–17.

12. Chakraborti C., Samanta S.K., Faiduddin K., Choudhury K.P., Kumar S., Mondal R. Bilateral central serous chorio-retinopathy in pregnancy presenting with severe visual loss. Nepal J. Ophthalmol. 2014;6(2):220–3.

13. Maggio E., Polito A., Freno M.C., Pertile G. Multimodal imaging findings in a case of severe Central Serous Chorioretinopathy in an uncomplicated pregnancy. BMC Ophthalmol. 2015;15:183. DOI: 10.1186%2Fs12886-015-0169-x

14. Краснощекова Е.Е., Бойко Э.В., Шадричев Ф.Е. Эволюция взглядов на выбор метода родоразрешения в зависимости от состояния глазного дна у беременных с периферической витреохориоретинальной дистрофией и регматогенной отслойкой сетчатки. Офтальмологические ведомости. 2011;4(2):62–67. [Krasnoshchekova E.E., Boyko E.V., Shadrichev F.E. Evolution of views on the choice of the method of delivery depending on the state of the fundus in pregnant women with peripheral vitreochorioretinal dystrophy and rheumatogenic retinal detachment. Ophthalmology journal=Oftal’mologicheskie vedomosti. 2011;4(2):62–67. (in Russ.)]

15. Коленко О.В., Сорокин Е.Л. Родоразрешение при миопии у беременных женщин, выбор тактики. 2016; (3): 64–68. [Kolenko O.V., Sorokin E.L. Delivery in pregnant women with myopia, the choice of tactics. Ophthalmosurgery=Oftal’m okhirurgiya. 2016;(3):64–68. (in Russ.)] DOI: 10.25276/0235-4160-2016-3-64-68

16. Петраевскии? А.В., Гндоян А.В. Оценка реальных факторов риска отслои?ки сетчатки и определение показании? к профилактическои? лазер-коагуляции сетчатки у беременных. Офтальмология. 2006;3(3):48–54. [Petraevskii? A.V., Gndoyan A.V. Evaluation of real risk factors for retina detachment and determination of indications for prophylactic laser coagulation of the retina in pregnant women. Оphthalmology in Russia=Oftal’mologiya. 2006;3(3):48–4. (in Russ.)]

17. Neri A., Grausbord R., Krermer I., et al. The management of labor in high myopic patients. Eur. J. Obstet. Gynecol. Reprod. Biol. 1985;19(5):277–279.

18. Erdei A., Steiber Z., Molnar C., Berenyi E., Nagy E.V. Exophthalmos in a young woman with no graves’ disease — a case report of IgG4-related orbitopathy. BMC Ophthalmol. 2018;18(1):5. DOI: 10.1186/s12886-018-0672-y

19. Garg P., Aggarwal P. Ocular changes in pregnancy. Nepal J. Ophthalmol. 2012;4(1):150–61.

20. Watson D.L., Sibai B.M., Shaver D.C., Dacus J.V., Anderson G.D. Late postpartum eclampsia: an update. South Med. J. 1983;76:1487–9.

21. Folk J.C., Weingeist T.A. Fundus changes in toxaemia. Ophthalmology. 1981;88:1173–4.

22. Sharma S., Wuntakal R., Anand A., Sharma T.K., Downey G. Pregnancy and the eye. The Obstetrician & Gynaecologist. 2006;8:141–146.

23. Синчихин С.П., Рамазанова Л.Ш., Мамиев О.Б. и др. Беременность и заболевания глаз (обзор литературы). Гинекология. 2016;1 (6):43–50. (in Russ.)

24. Vila-Arteaga J, Suriano M.M., Martinez-Lajara A. Cilioretinal obstruction during pregnancy. Arch. Soc. Esp. Oftalmol. 2016;S0365–6691(16):30224-6. DOI: 10.1016/j. oftal.2016.10.020

25. Jafarzadehpur E., Kermani R. M., Mohhamadi A.R., Nateghi M.R., Fazeli A.S., Kashi K.M. Ocular Manifestations in Infants Resulted from Assisted Reproductive Technology (ART). Journal of Family and Reproductive Health. 2013;7(4):181–6.

26. Parihar J.K., Kaushik J., Jain V.K., Naredi N., Raina S. The effect of assisted reproductive technology on ocular assessments. Clin. Exp. Optom. 2016;99(6):575–579. DOI: 10.1111/cxo.12389

27. Adcock E.W., III Cyclopentolate (Cyclogyl) toxicity in pediatric patients. J. Pediatr. 1971; 79 (1):127–129. DOI: 10.1016/S0022-3476(71)80074-4

28. Borromeo-McGrail V., Bordiuk J.M., Keitel H. Systemic hypertension following ocular administration of 10 percent phenylephrine in the neonate. Pediatrics. 1973;51:1032–1036.

29. Editorial: Babies’ blood pressure raised by eye drops. BMJ. 1974;1(5896):2–3. DOI: 10.1136/bmj.1.5896.2-a

30. Vaajanen A., Vapaatalo H. A Single Drop in the Eye — Effects on the Whole Body? Open Ophthalmol J. 2017;11:305–314. DOI: 10.2174/1874364101711010305

31. Salim S. Glaucoma in pregnancy. Curr. Opin. Ophthalmol. 2014;25(2):93–97. DOI: 10.1097/ICU.0000000000000029

32. Coppens G., Stalmans I., Zeyen T. Glaucoma medication during pregnancy and nursing. Bull. Soc. Belge Ophtalmol. 2010; 314 (314):33–36.

33. Razeghinejad M.R., Tania Tai T.Y., Fudemberg S.J., Katz L.J. Pregnancy and glaucoma. Surv. Ophthalmol. 2011;56 (4):324–335. DOI: 10.1016/j.survophthal.2010.11.008

34. Sethi H.S., Naik M., Gupta V.S. Management of glaucoma in pregnancy: risks or choices, a dilemma? Int. J. Ophthalmol. 2016;9(11):1684–1690.