Pathological changes in the eyes during pregnancy. Evaluation of the effectiveness of treatment

A woman's eyes, like all organs and systems, experience some changes during pregnancy and childbirth. Therefore, expectant mothers should be examined by an ophthalmologist twice during the period of expectation of the child. If a woman had certain pathologies of vision even before pregnancy, she is under the constant supervision of not only a gynecologist, but also an ophthalmologist. Consider what happens to the eyes during pregnancy, and what problems with vision may occur.

Eyes during pregnancy

When carrying a child in a woman's body, the level of the hormone estrogen increases. It affects the connective tissue, which can lead to a slight lengthening of the eyeball, a change in the vitreous body. As a result, fluctuations in intraocular pressure, dryness of the cornea are possible. All this contributes to the appearance of “flies” before the eyes, deterioration of vision, and difficulties in wearing contact lenses.

The structure of the eye that is most sensitive to changes is the retina, a thin layer of nervous tissue that is located on the inside of the back of the eyeball and absorbs light. The changes that occur in the eyeball and blood vessels sometimes lead to foci of delamination, thinning, areas of dystrophy (malnutrition), and retinal hemorrhages. In most cases, all these changes are not felt by a woman and can only be established during an examination by an ophthalmologist. That's why it's so important not to ignore an eye exam during pregnancy.

Eye problems during pregnancy

Sometimes the expectant mother notices frightening manifestations associated with vision or the condition of the eyes. Most of them are not dangerous and are just a "side" effect of pregnancy.

Edema of the eyelids is quite common in pregnant women, especially often in the morning. For their prevention, a woman needs first of all to reconsider her diet and drink. You should reduce the amount of foods with a high salt content in the diet, as well as consume a sufficient amount of fluid. If these measures do not help, you should consult a doctor.

The flashing of “dots” and “flies” before the eyes during pregnancy is often explained by vascular disorders, in particular, spasms of the fundus vessels. Therefore, in this case, you should not delay the visit to the ophthalmologist.

A change in the hormonal balance in the body of a pregnant woman provokes a decrease in the production of tear fluid. This contributes to the appearance of dry eyes, photophobia, foreign body sensation in the eyes. These symptoms usually go away after childbirth.

Increased sensitivity of the cornea during childbearing often leads to significant discomfort when wearing contact lenses. Especially annoying discomfort in the last three months of pregnancy. Experts recommend in this case to temporarily abandon the lenses and use glasses.

Another common eye disease during pregnancy is a spasm of the accommodative muscle, which is located inside the eyes. Symptoms of this pathology are eye fatigue, decreased distance visual acuity, blurred vision. This condition may disappear after childbirth, but in some women it turns into myopia. Therefore, when these symptoms appear, it is better to consult a specialist.

Pregnancy sometimes worsens the state of visual functions in pathologies of the optic nerve and fundus, as well as in myopia. This is due to the large loads on the body, changes in the hormonal background, the circulatory system. Only regular monitoring of pregnant women with these pathologies by an ophthalmologist can prevent possible visual complications.

Features of childbirth with eye diseases

If eye diseases are detected during pregnancy or the woman had vision problems even before conception, the doctor faces the task of choosing the right method of childbirth. In other words, the doctor decides the advisability of carrying out the birth process using a caesarean section.

Indications for caesarean section are the following conditions:

• High degree of myopia in the only functioning eye;
• Complicated rapidly progressive high myopia;
• A high degree of myopia is combined with obstetric pathology or extragenital pathology (diseases of the cardiovascular, respiratory or digestive systems);
• The appearance during pregnancy of pathological changes in the fundus, such as retinal detachment, optic nerve edema, retinal hemorrhage.

Eye drops during pregnancy

Many women experience eye conditions during pregnancy that require medication. It is important not to self-medicate while waiting for the child and use only the drugs that the doctor will prescribe. In addition, before using any medications, you should read the instructions for them. You can use those funds, in the annotation to which the safety of admission during pregnancy is indicated.

In the first trimester of pregnancy, it is not recommended to use eye drops containing beta-blockers and carbonic anhydrase inhibitors. It has been proven that these substances adversely affect the fetus. 4.9 out of 5 (23 votes)

Several conditions can be attributed to the causes of vision loss:

• hormonal changes;
• the presence of concomitant extragenital pathology - diabetes mellitus, hypertension, kidney disease;
• development of preeclampsia or eclampsia.

Under the influence of hormones, the elasticity of the sclera increases and, as a result, the anteroposterior size of the eyeball increases. An increase in the size of the eye leads to an increase in myopic refraction.

On a note! Not all women experience an increase in the size of the eyeball. This is due to the fact that some people have a predisposition to such processes. For example, if a woman already has refractive errors, then she has a higher risk of reduced vision than a woman with normal refraction.

The cornea also suffers from the action of hormones - dry eye syndrome may develop. If left untreated, dry eyes can lead to clouding of the cornea.

With uncompensated diabetes mellitus, the lens swells, as a result of which it changes its curvature and vision decreases. Elevated blood glucose has a negative effect on the retina and can also cause corneal edema.

If preeclampsia or eclampsia develops, then even a short-term loss of vision is possible. Also, with severe degrees of gestosis, the risk of developing retinal vascular thrombosis increases, with the development of which there is a significant decrease in visual acuity.

Vision correction in a pregnant woman

Any change in visual acuity must be corrected. During pregnancy, only 2 methods of correction can be used:

• wearing glasses;
• usage .

If the cause of the decrease in vision is any disease, then it is necessary to treat the underlying pathological process.

The preferred method of correction is the use of glasses. Glasses must be selected by an ophthalmologist on an individual basis.

Contact lenses are best used during the day. According to the wearing regime, preference is given to lenses with daily or frequent scheduled replacement (use period up to 2 weeks). When using contact lenses, it is important to follow the rules for storing and wearing them.

If during pregnancy a woman notices that she has begun to see poorly, then it is necessary to visit an ophthalmologist to get a new prescription for glasses or lenses.

Will vision be restored after childbirth?

The possibility of restoring vision after childbirth depends on the cause that caused its deterioration, as well as on the degree of changes that have already appeared in the eye.

If the decrease in visuas occurred as a result of stretching of the membranes of the eye, then its recovery after childbirth will not occur. In addition, a rapid increase in the size of the eyeball can lead to the appearance of pathological changes in the periphery of the retina. Therefore, within 6 months after childbirth, it is advisable to undergo an examination by an ophthalmologist.

Visual impairment associated with general diseases, as a rule, disappears after childbirth. The recovery process may take some time, so you need to see a doctor.

Symptoms of preeclampsia or eclampsia usually resolve within a few days after delivery. But if, against the background of preeclampsia, thrombosis of the retinal vessels occurred, then the deterioration of the condition is permanent. After delivery, intensive treatment of post-thrombotic retinopathy should be continued by an ophthalmologist.

Prevention of visual impairment during pregnancy

Preventive measures to maintain visual acuity include:

• observance of the visual mode;
• rejection of bad habits;
• early detection and treatment of extragenital pathology that affects the condition of the eyes;
• correctly selected correction in the presence of refractive errors.

Yulia Chernova, ophthalmologist, specially for the site

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Pregnancy is a special condition for a woman, which leads to many changes in her body. The eyes are also often subject to various changes, temporary dysfunction caused by the processes occurring during this period. Their diseases, in turn, can affect the course of pregnancy and the course of childbirth. It is important to be aware of this mutual influence and take the necessary measures in time.

Eye changes during pregnancy

During pregnancy, the eyes, their condition and functionality may undergo the following changes:

• Edema of the eyelids. As a rule, they occur in the morning and are associated with the diet. You should increase the intake of liquids (preferably pure non-carbonated drinking water or green tea) and reduce - salty foods.
• Dry eyes. Often accompanied by a sensation of a foreign body in the eye, photophobia (increased sensitivity to light). It is caused by a change in the hormonal background and a decrease in the secretion of the lacrimal gland. It disappears after childbirth without additional treatment.
• Flashing "dots", "spots". If this becomes a permanent phenomenon, then the problem lies in vascular disorders, in spasm of the vessels of the fundus. Requires immediate referral to an ophthalmologist.
• Concentric constriction. It consists in the fact that a woman ceases to distinguish colors on the periphery of her eyes. This is especially pronounced in the long term of pregnancy. This condition quite often accompanies the course of a normal pregnancy and disappears after childbirth.
• Spasm of the accommodative muscle. Symptoms: reduced distance visual acuity and some blurring, eye fatigue. It may just be a temporary change that will stop after childbirth, but it can also be a harbinger of myopia. When such changes appear, it is recommended to immediately contact an ophthalmologist to exclude possible complications.
• Discomfort when wearing lenses. Occurs as a result of increased sensitivity of the cornea. It is especially pronounced in the last trimester, disappears after childbirth. If the discomfort becomes unbearable, it is recommended to abandon the lenses and replace them with regular glasses.

Various changes are often associated with changes in intraocular pressure - it decreases, especially over long periods. The vessels narrow, which leads to all sorts of uncomfortable sensations, a temporary deterioration in the function of vision. Most of them do not require special treatment and disappear without a trace after the end of pregnancy. However, pathological changes are also possible, the result of which may be retinal detachment, partial or complete loss of vision. Therefore, it is recommended to be checked by an ophthalmologist at the beginning, middle and end of pregnancy. With the appearance of any discomfort, unusual phenomena, etc. you should visit a specialist more often, register if necessary.

Impact on existing diseases

Pregnancy can significantly complicate existing eye diseases. The risk group includes women with pathologies associated with lesions of the lens, retina, optic nerve, cornea and vascular tract. In order to avoid loss of vision, it is necessary not only to see an ophthalmologist regularly, but also to take appropriate measures during childbirth. This can be a gentle delivery - the imposition of obstetric forceps to reduce the period of attempts, in severe cases, a caesarean section is performed.

The most dangerous are optic neuritis and retinitis. Ordinary childbirth with such pathologies is contraindicated. A caesarean section is performed, and in especially dangerous cases, pregnancy is recommended. With these diseases, constant monitoring by a specialist is necessary, whose testimony will become a decisive factor.

Impact of eye diseases

In general, eye diseases do not significantly affect the course of pregnancy. However, two factors play an important role in their presence:

1. Taking medications. Must be very careful - you need to consult a specialist. A number of drugs may contain substances that are contraindicated during pregnancy, so the intake should be temporarily stopped or replaced with other drugs.
2. The course of childbirth. If there is a risk of retinal detachment or other negative changes due to pregnancy clearance, a caesarean section is indicated. In a number of diseases, experts advise termination of pregnancy in order to avoid complete loss of vision. You need constant monitoring by an ophthalmologist, strict adherence to all medical recommendations.

Myopia and hyperopia, a slight decrease in visual acuity are not potentially dangerous, but they definitely require an ophthalmologist's consultation. You may need additional medication, vitamin therapy, surgery to correct vision.

Eye infections during pregnancy

Infectious eye diseases during pregnancy are potentially dangerous because they can be transmitted to the fetus and cause pathological changes in the developing organs of vision. This includes a very common conjunctivitis, keratitis, purulent infection, scleritis, etc. Depending on the specific disease, the symptoms also differ. The most frequent manifestations:

• Edema of the eyelids
• Painful swelling around the eyes
• Tearfulness
• Purulent discharge
• Redness of the eyes and the area around them
• Pain in the temporal region
• A sharp increase in body temperature

Any of these manifestations requires immediate treatment to a specialist. Delaying treatment is dangerous because infectious diseases are characterized by rapid progression and can cover the entire body. Self-medication is also contraindicated, since it is very difficult to determine on your own what kind of disease is taking place, how much it progresses, what effect it can have on the body of the mother and child.

To make an accurate diagnosis, you need to contact an ophthalmologist, a blood test. It is important to make sure that the disease does not have time to be transmitted to the baby. Otherwise, immediate treatment is necessary - untimely elimination can lead to loss of vision in a child, various eye pathologies. In order to avoid the occurrence of infectious diseases, it is necessary:

1. Treat common body infections promptly
2. Touch your eyes as little as possible
3. Observe all rules of personal hygiene
4. Take good care of your contact lenses and glasses
5. Change cosmetics more often and be attentive to her choice
6. Change bed linen regularly
7. Do not come into contact with carriers of the infection

Compliance with these simple rules will help to avoid the occurrence of infectious diseases and their possible complications.

Preparations

At the beginning of the second month of pregnancy, the fetus begins to receive all the substances that enter the mother's body, including medications. Therefore, it is very important to carefully consider the choice of eye drugs. Here are some guidelines for selection and admission:

• If you are already taking any medications, tell your doctor . After analyzing the composition of the drug, the specialist will say whether its further use is possible.
• Read the instructions . If you need an urgent medication and there is no way to get a doctor's advice, carefully read the indications and contraindications. Each medication must have an indication of whether it is permissible to take it for pregnant and lactating women. You can first consult with the sellers in the pharmacy.
• Contact a specialist for all questions . If eye drops, vitamins, and other drugs cause even the slightest concern, wait with them and consult a doctor.

Eye diseases and pregnancy have a great mutual influence. Therefore, pay considerable attention to your condition, follow all the changes, do not neglect the recommendations and visits of specialists. Timely treatment will help prevent the development of pathology or eliminate it.

In the last two decades, one not very pleasant trend has begun to be traced. A fairly large percentage of young women become pregnant for the first and subsequent times, having a whole bunch of chronic diseases. Most of these diseases, one way or another, will affect the bearing and birth of a baby, and it is not always possible to endure pregnancy with these diseases without problems. If a woman wants to bear and give birth to healthy babies, it is worth taking care of pregnancy planning in advance and learning in advance about the peculiarities of the course of pregnancy with her chronic illness. Let's discuss in detail the most common groups of diseases.

Why is surveillance necessary?
No matter what they say about the ease of pregnancy and its rejuvenating effect, but pregnancy itself is a rather difficult test for the organs and systems of a woman - the kidneys, heart and liver experience double stress, and the nervous and endocrine systems are actively working, immunity. This is due to the fact that to ensure the best supply of the placenta and through it the baby with nutrients, and the mother's body remains in the background.

That is why it is important that by the time of conception the mother's disease be cured or brought into maximum remission, that is, the organs and systems of her body can work as efficiently as possible. Any chronic disease always, even minimally, but still affects the course of pregnancy, and in addition - there is an inverse pattern - pregnancy itself affects the development of the disease and its course. When planning pregnancies, it is important to list any health problems in your body, this will allow you to refer you to a therapist or subspecialists.

Chronic non-gynecological (they are called extragenital) diseases - this is the pathology that a woman suffered from before pregnancy from childhood or young years, in general, she had this disease for a long time. These women have a high risk of developing pregnancy problems, which is why it is important for them to be observed more carefully and for a long time not only by an obstetrician-gynecologist, but also by narrow specialists and a therapist, and it would be better if this is the same doctor that previously treated the woman .

Another serious issue is the mother's use of various drugs to treat the disease, many of which can seriously harm the baby in the doses that the mother takes. Therefore, dose adjustment or replacement of the drug with one that is possible during pregnancy is necessary. In addition, it is necessary to prevent the development of exacerbations of the disease and its complications. which can harm the child.

The ideal option for pregnancy is to plan it step by step in tandem with doctors, carefully treating all the “old wounds” and bringing them into stable remission. This inactive state of the disease is not dangerous for the development of the fetus. Unfortunately, we often come across already pregnant women who have chronic pathologies, and at best they come to register - at worst - they end up in a hospital with pregnancy and an exacerbation of the disease. At the same time, our medical task is to save the life and health of the fetus, completely curing the mother.

At the same time, I note that not all diseases and conditions forbid getting pregnant and giving birth to children, most health problems and chronic sores completely allow you to give birth to healthy children. However, pregnancy in chronic pathology is always a risk and it is worth “laying straws”, being examined and actively observed, following all the recommendations.

When will we respond?
There are situations when pregnancy and childbirth can become deadly for a woman, and then doctors will strongly recommend that you abandon the idea of ​​\u200b\u200bpregnancy. However, they will tell you about all the dangers, but they have no right to forbid you to give birth, if you decide to risk your life and the life of the fetus, doctors will monitor you day and night.

Pregnancy is dangerous when:
- severe combined heart defects with impaired blood circulation, shortness of breath, edema and arrhythmias.
- in severe hypertension with severe circulatory disorders,
- with lung diseases that occur with severe respiratory failure,
- in chronic renal failure in the final stages of renal disease.
- with scleroderma or systemic lupus erythematosus, rheumatic diseases,
- with severe endocrine diseases - diabetes mellitus, thyrotoxicosis, adrenal insufficiency.
- with leukemia and malignant tumors,
- with hereditary metabolic disorders,
- with epilepsy,
- with cirrhosis of the liver.
In such cases, by the decision of the woman and the agreement of the medical council of doctors, she may be offered surgical sterilization, since becoming pregnant can be deadly for her.

There is also a group of temporary contraindications for pregnancy - these are factors that can subsequently be eliminated with active treatment and rehabilitation. It is usually not recommended to become pregnant during an exacerbation of the disease and during infectious processes. Pregnancy is not allowed for a year after abdominal surgery or a very sharp weight loss, after chemotherapy or radiation, when taking very serious drugs that are dangerous to the fetus. Your doctor will tell you the time you need to wait before pregnancy.

Pregnancy in diseases of the heart and blood vessels.
The heart and blood vessels are necessary to sustain life - blood flows through them. The course and outcome of any pregnancy depends on the condition of the heart. If a woman has problems in the health of the heart or vascular system, she needs to see a cardiologist before pregnancy and during all 40 weeks.

Serious diseases in the heart and blood vessels are associated with a high risk to the health of both, however, it is quite possible to endure and give birth to a healthy baby - however, both obstetricians and cardiologists will immediately follow you - each in their own field. If the first signs of a violation of well-being and heart function suddenly appear, they will immediately be admitted to a specialized perinatal center at any stage of pregnancy. Cardiologists, together with obstetricians, will also decide on the method of childbirth - whether it is possible to give birth on her own or is it better to do a CS.

If a woman has heart defects, pregnancy is possible and the decision on its management is made together with a cardiologist even in the early stages. Cardiac disorders can occur during critical periods of pregnancy - in the early period up to 12 weeks, and then at about 28-32 weeks, when the load on the woman's cardiovascular system increases dramatically. Another critical period may be the time immediately after childbirth - after all, this is a sharp change in the load and blood circulation.

Why are decompensated heart defects dangerous? These are usually late toxicoses - preeclampsia and the development of fetal hypoxia, this is the risk of premature birth and intrauterine death of the fetus, delays in its development and the formation of its diseases. Therefore, before planning a pregnancy, you need to undergo an examination and establish the severity of the defect and its compensation, that is, how well the body copes with impaired blood flow and stress.

A woman will have a lot of examinations - blood tests - general and biochemistry, blood for coagulation, and besides this, an ECG, PCG and ultrasound of the heart are mandatory, this will allow you to evaluate the work of the heart and its structure. If a heart defect is acquired due to rheumatism, then everything will depend on the severity of the defect and on what stage the rheumatism is in, whether there is heart failure and how the woman turns gray and feels herself in life.

Today, it is possible to plan a pregnancy a year after the defect has been surgically corrected, however, if a woman has artificial heart valves, she will be examined in detail in a hospital three times during pregnancy - at twelve weeks they will examine the condition of the heart and the operation of the valves, and choose drug therapy that is safe for the fetus , from a period of 26 to 38 weeks, drug therapy will be evaluated and its correction will be carried out based on the size of the fetus and the load, and after 36 weeks the woman will be put in to prepare for childbirth and decide on the method of delivery - whether the woman can give birth herself or is it worth having a caesarean section.

In the presence of high blood pressure, the issue is resolved with a cardiologist, usually pregnancy and childbirth are quite acceptable, it is impossible only with pressure numbers above 200 to 115. The danger of such a pregnancy is in the development of preeclampsia, placental abruption and intrauterine fetal growth retardation, the formation of chronic oxygen starvation and therefore, it is necessary close monitoring of the woman throughout pregnancy. Usually, women undergo planned hospitalizations with examinations in each trimester - just like with defects, they decide in the early stages whether to maintain pregnancy, and then it is decided which drugs and tactics for managing a woman are chosen. With an increase in pressure, you can give birth on your own, only they do epidural anesthesia.

With reduced pressure, you can get pregnant and give birth, only drugs will be needed to stabilize the pressure, during pregnancy there is usually a tendency to lower it. In severe hypotension, hypoxia can form in the fetus, which leads to impaired growth and development. Then the risk of miscarriages and IUGR increases, such women are constantly monitored by doctors. Childbirth usually takes place on its own - with the use of anesthesia.

Also, vision problems during pregnancy sometimes occur in absolutely healthy women. To avoid serious consequences that can threaten not only you, but also the baby, it is very important to be examined by an ophthalmologist in a timely manner and take care of your own vision.

Complications of eye diseases during pregnancy

During pregnancy, the course of eye diseases associated with damage to the lens and cornea, as well as the vascular nerve and retina, is often complicated. Pathologies of the retina and optic nerve are considered one of the most difficult in pregnant women. Most often, their manifestations are associated with nephritis or severe preeclampsia. Unfortunately, when optic neuritis is detected, termination of pregnancy is indicated. Similar measures are required for retinal detachment, regardless of the cause of this phenomenon.

Myopia is another common ophthalmic disease. In an uncomplicated pregnancy, worsening of the course of the disease, as a rule, does not occur, but the progression of the pathology is possible if you experience early or late toxicosis. Visual impairment in myopia is associated with a decrease in intraocular pressure and circulatory deficiency. If you have already been diagnosed with myopia, it is recommended to approach pregnancy planning very responsibly, after consulting with a specialist.

Throughout the entire period of pregnancy, the development of complications such as retinal hemorrhage or its detachment is possible. In such situations, you will need an urgent consultation with an ophthalmologist and subsequent treatment.

Sometimes vision during pregnancy may deteriorate somewhat, even if you have not experienced eye problems before: this happens especially often with preeclampsia and anemia. Quite often, women note dryness and irritation of the eyes, as well as "flickering flies", which is usually associated with changes in blood pressure.

The most serious complication is retinal dystrophy. Due to sudden changes in intraocular pressure during attempts, serious changes in the fundus of the eye, retinal detachment and other complications can occur, up to complete loss of vision. To avoid this, you should see your optometrist regularly. If the examination reveals signs of retinal dystrophy, you may be shown laser photocoagulation, after which delivery will be possible in a natural way.

Ophthalmic examination and management of pregnancy

In some cases, the obstetrician-gynecologist who observes you will recommend that you undergo a comprehensive ophthalmological examination, which, if there are diseases, will help doctors develop optimal pregnancy management tactics. Typically, this examination includes:

• echography;
• visiometry;
• ophthalmoscopy;
• ophthalmometry;
• examination of the fundus and retina;
• a number of biomicroscopic studies.

If you have ophthalmic pathologies, pregnancy management should be carried out with regular observation by an ophthalmologist. It is also worth considering that a number of eye diseases can be inherited by your unborn baby. In this case, it is advisable to consult a geneticist.

How is childbirth going?

Childbirth with pathologies of the organs of vision can take place both naturally and by caesarean section. If the disease does not proceed in a pronounced form, the fetus feels good, and the ophthalmologist has issued an appropriate conclusion, natural childbirth is not contraindicated for you. Often in the process of natural childbirth, it becomes necessary to reduce the period of attempts, for this obstetric forceps are used.

A caesarean section must be carried out without fail in case of retinal detachment in late pregnancy or directly in the process of delivery. Also, natural childbirth is contraindicated for women who have undergone previous retinal surgery. Other indications for caesarean section are a high degree of myopia and increased intraocular pressure.

Prevention of ophthalmic diseases

1. To prevent complications of eye diseases during pregnancy, you may be prescribed vitamin therapy, calcium supplements, as well as mandatory dynamic monitoring by an ophthalmologist.
2. If you wear contact lenses, then during pregnancy it is recommended to switch to glasses, which will reduce the risk of developing an inflammatory process and dry eye syndrome.
3. If necessary, the doctor will select special eye drops, the use of which is not contraindicated during pregnancy. It is very important not to take medications without first consulting a specialist, since not all drugs are safe for the fetus.
4. In addition, a diet rich in vitamins A, C, E and B2 will be a good help for maintaining vision.
5. It is also recommended to regularly perform simple exercises for the eyes, avoid prolonged sitting at the computer or in front of the TV, and spend as much time as possible in the fresh air.