Download Eye manifestations during pregnancy(slide show)

Eye manifestations during
pregnancy
By
Dr Mohamed Abusharifa, MD
Ophthalmic surgeon
Tulkarem - Palestine
1
TARGET
To highlight those the eye problems,
which are related with pregnancy,
without interfering into treatment modalities
2
Eye manifestations during
pregnancy
Ocular changes that occur in pregnancy
are usually TRNSIENT in nature, but
occasionally there may be PERMANENT
disorders
3
Courtesy of: Sunness JS. The pregnant woman’s eye.
Surv of Ophthalmology 1988;32:219-38
PLAN
1. NEURO-OPHTHALMOLOGICAL
changes appearing in pregnancy
2. The effects of pregnancy on PRE-EXISTING
ocular disorders
3. Ocular disorders associated with
PREGNANCY-RELATED diseases
4. Eye changes developing
DURING PREGNANCY
4
BUT BEFORE proceeding into
presentation
please pay attention to the following
5 slides :
5
1
6
nausea + severe vomiting +
severe headache + intracranial
disorders in a pregnant
Newborn with hydrocephalus due to
congenital toxoplasmosis
2
7
(From Dubey JP, and Beattie CP. Toxoplasmosis of
animals and Man. CRC Press, Baca Raton, Florida, 52,
1988.)
A toxoplasmosis lesion
in the center of retina
8
3
Normal retina
Courtesy of KANSKI : Clinical Ophthalmology
4
Diabetic retinopathy
9
Normal retina
Courtesy of KANSKI : Clinical Ophthalmology
5
NO contact lenses
during pregnancy
=
10
X
Now presentation starts:
1. NEURO-OPHTHALMOLOGICAL
changes appearing in pregnancy
2. The effects on PRE-EXISTING
ocular disorders
3. Ocular disorders associated with
PREGNANCY-RELATED diseases
4. Eye changes developing
DURING PREGNANCY
11
NEURO-OPHTHALMOLOGICAL
changes appearing in pregnancy
Some of the symptoms which are regarded
normal in pregnancy, such as :
nausea & vomiting
may be signs of intracranial disorders
Courtesy of: T. Walsh, Neuro-Ophthalmology
12
Clinical Signs & Symptoms
NEURO-OPHTHALMOLOGICAL
changes in pregnancy
Nausea & severe vomiting should be
considered seriously while doing D.D. in
a pregnant having:
Visual disturbances
Persistent headache
Visual field defects
Oculomotor palsies
Courtesy of: T. Walsh, Neuro-Ophthalmology
13
Clinical Signs & Symptoms
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
Pseudotumor cerebri
(benign intracranial hypertension)
Prolactinoma (adenoma of pituitary gland)
Venous sinus thrombosis
14
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
Pseudotumor cerebri
(benign intracranial hypertension)
Prolactinoma (adenoma of pituitary gland)
Venous sinus thrombosis
15
NEURO-OPHTHALMOLOGICAL
changes in pregnancy
Pseudotumor cerebri
(benign intracranial hypertension)
Typical symptoms & findings:
– Blur vision
– Headache
– Nausea & severe vomiting
– 6th nerve palsy
– Edema of optic disc
Courtesy of: T. Walsh, Neuro-Ophthalmology
16
Clinical Signs & Symptoms
nausea + severe vomiting +
severe headache
17
Right Lateral Rectus
Muscle palsy due to
Righ 6th nerve palsy
Left Lateral Rectus
Muscle palsy due to
Left 6th nerve palsy
Courtesy of KANSKI: Clinical Ophthalmology
18
EDEMA OF OPTIC DISC
Normal optic disc
19
Courtesy of: T. Walsh, Neuro-Ophthalmology
Clinical Signs & Symptoms
edema of optic disc
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
• Pseudotumor cerebri
(benign intracranial hypertension)
• Prolactinoma
(adenoma of pituitary gland)
20
• Venous sinus thrombosis
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
• Pseudotumor cerebri
(benign intracranial hypertension)
• Prolactinoma
(adenoma of pituitary gland)
21
• Venous sinus thrombosis
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
Prolactinoma
A noncancerous tumor (adenoma)
affecting the pituitary gland that causes
increase in the production of the
hormone prolactin (LTH)
22
NEURO-OPHTHALMOLOGICAL
changes in pregnancy
Prolactinoma
Symptoms & findings:
• Galactorrhea
• Amenorrhea
• Fatigue
• Decreased libido
• Headache
• Visual disturbances (due to pressure on the optic
nerve)
• Visual field defects (due to pressure on the optic
chiasm)
23
Pituitary gland
24
Pituitary gland pressing on
optic chiasm from below
25
Optic chiasm
Optic nerve
tip
26
Courtesy of: Dynamic Human Anatomy
Student Version
Enlarged sella turcica due to pressure
caused by pituitary adenoma
27
normal Visual field in Left Eye
Pt’s view
28
Courtesy of D. J. Spalton: Atlas of CLINICAL OPHTHALMOLOGY
normal visual field in Right Eye
Pt’s view
29
Courtesy of D. J. Spalton: Atlas of CLINICAL OPHTHALMOLOGY
Asymmetric bitemporal visual field loss
e to pressure on the optic chiasm & optic
nerve from below
30
Courtesy of Visual Fields: Examination & Interpretation
Publication of American Academy of Ophthalmology
Pituitary adenoma (prolactinoma)
31
Courtesy of Visual Fields: Examination & Interpretation
Publication of American Academy of Ophthalmology
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
Prolactinoma
It is recommended that any pregnant with a
known pituitary prolactinoma must
have regular visual field follow-up to rule
out enlargement which leads to
compression of optic chiasm and causes
uncorrected visual field loss
32
Courtesy of Visual Fields: Examination & Interpretation
Publication of American Academy of Ophthalmology
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
• Pseudotumor cerebri
(benign intracranial hypertension)
• Prolactinoma
(adenoma of pituitary gland)
• Venous sinus thrombosis
33
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
• Pseudotumor cerebri
(benign intracranial hypertension)
• Prolactinoma
(adenoma of pituitary gland)
• Venous sinus thrombosis
34
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
Venous sinus thrombosis
is a form of brain stroke that results from
thrombosis of the dural venous sinuses
35
Courtesy of Lanska DJ, Kryscio RL. Risk factors for peripartum & pastpartum stroke& intracranial
venous thrombosis. Stroke 2000;31:1274-82
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
Venous sinus thrombosis
Increased risk of occurrence in :
Cesarean delivery
Advanced maternal age
Hypertension
Infections
36
Courtesy of Lanska DJ, Kryscio RL. Risk factors for peripartum & pastpartum stroke& intracranial
venous thrombosis. Stroke 2000;31:1274-82
Venous sinuses
37
NEURO-OPHTHALMOLOGICAL cases
included in DD during pregnancy:
Venous sinus thrombosis
Signs & symptoms:
 Throbbing headache
 Focal or generalized seizures
 Paresis
 Optic disc edema
38
Courtesy of Lanska DJ, Kryscio RL. Risk factors for peripartum & pastpartum stroke& intracranial
venous thrombosis. Stroke 2000;31:1274-82
nausea + severe vomiting +
severe headache
39
Venous sinus thrombosis
thrombus
40
Courtesy of Lanska DJ, Kryscio RL. Risk factors for
peripartum & pastpartum stroke& intracranial venous
thrombosis. Stroke 2000;31:1274-82
EDEMA OF OPTIC DISC
Normal optic disc
41
Courtesy of: T. Walsh, Neuro-Ophthalmology
Clinical Signs & Symptoms
edema of optic disc
PLAN
1. NEURO-OPHTHALMOLOGICAL
changes appearing in pregnancy
2. The effects on PRE-EXISTING
ocular disorders
3. Ocular disorders associated with
PREGNANCY-RELATED diseases
4. Eye changes developing
DURING PREGNANCY
42
The effects of pregnancy on
PRE-EXISTING ocular disorders
–
–
–
–
43
Diabetic retinopathy
Graves’ disease
Glaucoma
Uveitis
The effects of pregnancy on
PRE-EXISTING ocular disorders
–
–
–
–
44
Diabetic retinopathy
Graves’ disease
Glaucoma
Uveitis
The effects of pregnancy on
PRE-EXISTING ocular 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
45
The effects of pregnancy on
PRE-EXISTING ocular disorders
Diabetic retinopathy
its progression is affected by :
1. Duration of DM
2. Presence of diabetic retinopathy at
conception
3. Sugar control during pregnancy
46
Courtesy of Sheth BP. Does pregnancy accelerate the rate of progression of
diabetic retinopathy? Curr Diab Rep 2002;2:327-30
The effects of pregnancy on
PRE-EXISTING ocular disorders
Diabetic 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
47
The effects of pregnancy on
PRE-EXISTING ocular disorders
Diabetic retinopathy
48
Normal retina
Courtesy of KANSKI : Clinical Ophthalmology
The effects of pregnancy on
PRE-EXISTING ocular disorders
Diabetic retinopathy
49
laser photocoagulation
The effects of pregnancy on
PRE-EXISTING ocular disorders
•
•
•
•
50
Diabetic retinopathy
Graves’ diseas
Glaucoma
Uveitis
The effects of pregnancy on
PRE-EXISTING ocular disorders
•
•
•
•
51
Diabetic retinopathy
Graves’ diseas
Glaucoma
Uveitis
The effects of pregnancy on
PRE-EXISTING ocular disorders
Graves’ disease
Pre-existing hyperthyroidism can be
aggravated in pregnancy.
52
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
The effects of pregnancy on
PRE-EXISTING ocular disorders
The initial onset of Graves’ disease
may occur during pregnancy
53
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
The effects of pregnancy on
PRE-EXISTING ocular disorders
Thyroid ophthalmopathy
54
Courtesy of KANSKI : Clinical Ophthalmology
The effects of pregnancy on
PRE-EXISTING ocular disorders
•
•
•
•
55
Diabetic retinopathy
Graves’ disease
Glaucoma
Uveitis
The effects of pregnancy on
PRE-EXISTING ocular disorders
•
•
•
•
56
Diabetic retinopathy
Graves’ disease
Glaucoma
Uveitis
Glaucoma
(increase in intraocular pressure)
leads to:
optic disk atrophy
loss in visual field
57 Courtesy of F. Newell: Ophthalmology principles & concepts
NORMAL OPTIC DISK
58
atrophic glaucomatous
optic disk
Courtesy of Kanski: CLINICAL OPHTHALMOLOGY
Progression of glaucomatous visual field loss
59
Courtesy of Kanski: CLINICAL OPHTHALMOLOGY
The effects of pregnancy on
PRE-EXISTING ocular disorders
During pregnancy occurs
decrease in intraocular
pressure (temporary control) !!!
Courtesy of Johnson SM, Martinez M, Freedman S. Management of glaucoma in
pregnancy & lactation. Surv. Ophthalmol 2001;45::449-54
60
The effects of pregnancy on
PRE-EXISTING ocular disorders
–
–
–
–
61
Diabetic retinopathy
Graves’ disease
Glaucoma
Uveitis
The effects of pregnancy on
PRE-EXISTING ocular disorders
–
–
–
–
62
Diabetic retinopathy
Graves’ disease
Glaucoma
Uveitis
The effects of pregnancy on
PRE-EXISTING ocular disorders :
Uveitis
A non-infectious inflammation of uvea,
which sometimes accompanies
inflammations of connective tissue:
arthritis, spondyloarthritis ….etc
Courtesy of F. Newell: Ophthalmology principles & concepts
63
The effects of pregnancy on
PRE-EXISTING ocular disorders
During pregnancy also occurs
temporary improvement of uveitis !!!
Courtesy of Sunness JS, Santos A, Pregnancy & the Mother’s eye:
Lippincott Williams & Wilkins;2001
64
PLAN
1. NEURO-OPHTHALMOLOGICAL
changes appearing in pregnancy
2. The effects on PRE-EXISTING
ocular disorders
3. Ocular disorders associated with
PREGNANCY-RELATED diseases
4. Eye changes developing
DURING PREGNANCY
65
Ocular disorders associated with
PREGNANCY- RELATED diseases
o Toxoplasmosis
o Toxemic retinopathy of pregnancy
66
Ocular disorders associated with
PREGNANCY- RELATED diseases
o Toxoplasmosis
o Toxemic retinopathy of pregnancy
67
Toxoplasmosis
Is an infection caused by the
intracellular protozoon
(Toxoplasma gondii), by
ingestion of raw or
undercooked meat
containing oocysts, or by
exposure to oocysts in
cat feces
68
Fabiana Maria Ruiz Lopes - Toxoplasma gondii infection in pregnancy
Brazilian Journal of Infectious Diseases
Neonatal congenital toxoplasmosis
It is acquired transplacentally, which may cause:
•
•
•
•
•
Abortion
Miscarriage or stillbirth
Chronic chorioretinitis
blindness
Severe jaundice & hepatosplenomegaly
CNS lesions:
– Hydrocephalus
– Intracerebral calcification
– Mental retardation
– convulsions
69
Fabiana Maria Ruiz Lopes - Toxoplasma gondii infection in pregnancy
Brazilian Journal of Infectious Diseases
Girl with hydrocephalus due to
congenital toxoplasmosis.
70
Brain calcification in
congenital toxoplasmosis
(From Dubey JP, and Beattie CP. Toxoplasmosis of
animals and Man. CRC Press, Baca Raton, Florida, 52,
1988.)
Ocular disorders associated with
PREGNANCY- RELATED diseases
Toxoplasmosis lesion in center
of retina
71
Normal retina
Courtesy of KANSKI : Clinical Ophthalmology
Suggestion
•
•
72
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
Ocular disorders associated with
PREGNANCY- RELATED diseases
o Toxoplasmosis
o Toxemic retinopathy of pregnancy
73
Ocular disorders associated with
PREGNANCY- RELATED diseases
o Toxoplasmosis
o Toxemic retinopathy of pregnancy
74
Ocular disorders associated with
PREGNANCY- RELATED diseases
Toxemic retinopathy of pregnancy occurs:
During pre-eclampsia
Premature separation of the placenta
(Abruptio placentae)
 Retention of dead fetus
75
Courtesy of: Sunness JS. The pregnant woman’s eye.
Surv of Ophthalmology 1988;32:219-38
Ocular disorders associated with
PREGNANCY- RELATED diseases





76
Toxemic retinopathy of pregnancy:
Cotton wool spots
Retinal hard exudates
Edema of optic disc
Retinal hemorrhages
Serous chorioretinopathy
Courtesy of: Sunness JS. The pregnant woman’s eye.
Surv of Ophthalmology 1988;32:219-38
Toxemic retinopathy of pregnancy
edema of optic disc & retinal hemorrhages
& cotton-wool spots & central exudates
77
Normal retina
Courtesy of KANSKI : Clinical Ophthalmology
Toxemic retinopathy of pregnancy
Central serous chorioretinopathy
78
Normal retina
Courtesy of KANSKI : Clinical Ophthalmology
PLAN
1. NEURO-OPHTHALMOLOGICAL
changes appearing in pregnancy
2. The effects on PRE-EXISTING
ocular disorders
3. Ocular disorders associated with
PREGNANCY-RELATED diseases
4. Eye changes developing
DURING PREGNANCY
79
Eye changes developing
DURING PREGNANCY
ON:
•
•
•
•
80
LIDS
CORNEA
TEARS PRODUCTION
LENS
Eye changes developing
DURING PREGNANCY
Chloasma
on LIDS
(Chloasma gravidarum)
(Mask of pregnancy)
Blotchy brown discoloration
around lids, due to
pigmentation
It fades in postpartum period
No treatment needed
Courtesy of Sushma Sharma - Review: Pregnancy and the eye
81
Eye changes developing
DURING PREGNANCY
Corneal edema on CORNEA
Increased corneal thickness
Due to fluid retention
This (edema) causes:
1. MYOPIC change
2. Intolerance to CL
due to traumatic
effects on corneal
surface
Normal corneal thickness
82
Courtesy of Sushma Sharma - Review: Pregnancy and the eye
Eye changes developing
DURING PREGNANCY
Decrease in tears production
in 80% of pregnant women
It causes Intolerance to wearing CL
Courtesy of Sushma Sharma - Review: Pregnancy and the eye
83
Pregnants are advised to
avoid wearing CL
=
84
Courtesy of Sushma Sharma - Review: Pregnancy and the eye
X
1. Eye changes developing
DURING PREGNANCY
on lens = increase in lens curvature
leads to: Temporary myopia
Increased
lens
curvature
85
Normal
lens
curvature
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
86
THANK YOU
87