First of all, congratulations! As a first time mom-to-be, I can attest that this is a very special (and very weird) time in your life. Your schedule is packed with prenatal appointments, childbirth classes, and yoga classes... but what about an eye exam? Just because you are expecting a baby doesn't mean you should put off your annual eye exam, especially if you are experiencing vision changes.
Related Post: Six Ways Pregnancy Can Affect Your Eyes
What to Expect at Your Eye Exam
While you are reviewing your health history with the technician, don't forget to tell them that you are pregnant, intending to become pregnant, or nursing. This is important information for your eye doctor to know for the reasons listed as follows. Overall, your eye exam will be very similar to what you've experienced in the past, with a few possible modifications (per the doctor's discretion):
1. Your Prescription
If your new prescription changes significantly, your eye doctor may discuss with you whether or not to change your prescription. They may decided to watch these changes instead of having you update your eyeglasses and/or contact lenses. The reason for this is the simple fact that your vision and prescription may temporarily change during pregnancy and return to normal afterwards. Therefore, it may not be worth the expense of purchasing new glasses and/or contact lenses during this time.
Related Post: Decoding Your Eyeglass Prescription
2. Routine Use of Eye Drops
Historically, the U.S. Food and Drug Administration assigned all drugs into one of five safety categories for pregnancy: A, B, C, D, and X. "Category A medications have proven safety (possibility of fetal harm appears remote); Category B drugs have presumed safety; Category C drugs have uncertain safety; and Category D medications are unsafe, although their benefits may be acceptable in certain situations despite the risk. Category X drugs are unsafe and contraindicated in women who are or may become pregnant; that is, the risk of using these medications outweighs any potential benefits." These guidelines have since been relabeled.
Most topical ophthalmic drugs fall into the old category C as they have uncertain safety due to limited human data (i.e., it's not legal or ethical to conduct drug trials on pregnant women). This means that these medications have not been found to be unsafe, but they also haven't been found to be safe, either. This is why your eye doctor may decide not to instill any drops in your eyes, dilation or otherwise, during your exam.
Here are the most common eye drops used during a routine examination and their associated risk:
- Topical ophthalmic dyes (e.g., fluorescein): generally considered safe in both pregnant and breastfeeding women.
- Anesthetics (e.g., proparacaine): generally considered safe in both pregnant and breastfeeding women.
- Mydriatic agents (e.g., tropicamide): should be used only when necessary during pregnancy and not at all during lactation.
- Cycloplegic agents (e.g., cyclopentolate, atropine): should not be used diagnostically and should be used with caution when necessary for therapeutic purposes.
Although a dilated eye exam is not routinely performed while a woman is pregnant or nursing, there are exceptions. Dilation is used only if you have a pre-existing condition, such as diabetic retinopathy, or are reporting signs or symptoms of a retinal detachment or another serious eye condition.
Related Post: Name That Eye Drop! A Cap Color Guide to Ophthalmic Drops
3. Medical Treatment for Eye Conditions
If you need to be treated for an eye condition with eye drops, your doctor may modify your treatment if you are pregnant, intend to become pregnant, or are currently nursing.
It is recommended that, after instilling any eye drop, lacrimal sac compression and eye drop closure techniques should be used to reduce systemic absorption. This means closing your eyes while gently pushing on the inner corner of your eye where the lacrimal sac is for 2 to 3 minutes.
Here's a non-exhaustive list of ophthalmic medications used for the treatment of ocular conditions that carry an unknown or unsafe risk (old category C or D) and are best to be avoided:
- Allergy (topical): antazoline, naphazoline, pheniramine, oxymetazoline, tetrahyrdozoline, zinc sulfate, olopatadine, pemirolast, ketotifen, epinastine, azelastine
- Antibiotics (topical and oral): gatifloxacin, moxifloxacin, levofloxacin, ofloxacin, ciprofloxacin, gentamicin, sulfacetamide, trimethoprim/polymyxin B, bacitracin, neomycin, tetracycline, tobramycin, doxycycline, sulfamethoxazole/trimethoprim
- Anifungals (topical): natamycin
- Antivirals (topical): trifluridine
- Glaucoma (topical and oral): beta blockers, prostaglandins, carbonic anhydrase inhibitors, miotics
- NSAIDs (topical): ketorolac tromethamine, diclofenac, nepafenac, bromfenac
- Steroids (topical and oral): rimexolone, loteprednol, prednisolone, fluorometholone, dexamethasone, prednisone, methylprednisolone
Here's a short list of ophthalmic medications that are presumed to be safe (old category B) but should always be verified before prescribing:
- Allergy (topical): emedastine, lodoxamide, nedocromil, cromolyn
- Antibiotics (topical and oral): erythromycin, azithromycin, cefadroxil, amoxicillin, amoxicillin/clavulanate, cephalexin, cefaclor
- Antivirals (oral): acyclovir, famciclovir, valacyclovir
- Glaucoma (topical): brimonidine
If treatment with eye drops is necessary, your eye doctor will ensure that the medication poses minimal risk to you and your baby, and provides maximum therapeutic benefit at the lowest possible dose. Make sure to tell your eye doctor who your OB/GYN or CNM is, so they can contact them to discuss treatment.