Management of glaucoma during pregnancy

Pearls Manager: Andrew Tatham

Women with glaucoma of child bearing age should be informed about the possible need to modify treatment during pregnancy and instructed to inform the ophthalmologist when pregnancy occurs. The potential risks to the foetus of continuing anti-glaucoma medications must be balanced against the risk of vision loss in the mother. As IOP generally decreases during pregnancy, for some, temporary treatment discontinuation can be considered. Laser trabeculoplasty is considered a safe alternative. If surgery is considered the use of antimetabolites is strictly contraindicated.

The majority of IOP-lowering medications are Class C, meaning adverse effects have been seen in animals or that there are no human or animal data. Brimonidine is a Class B medication however there are reports of central nervous system side effects in young children and so should be avoided when breastfeeding.

EGS Guidelines, 4th edition, Page 154

Razeghinejad MR, Tania Tai TY, Fudemberg SJ, Katz LJ. Pregnancy and glaucoma. Surv Ophthalmol 2011;56(4):324-35.