Pregnancy and glaucoma

Glaucoma, primarily a disease of the older population, may affect women of childbearing age. Pregnancy affects the intraocular pressure (IOP) of women with pre-existing glaucoma. Both elevations and reductions of IOP have been reported during pregnancy. Additionally, visual field test results may fluctuate during pregnancy. In managing the pregnant glaucoma patient with medical therapy, one must consider not only the systemic side effects on the mother, but also any potentially harmful effects on the developing fetus. All anti-glaucoma medications are categorized as class C by the Food and Drug Administration, except brimonidine and nonspecific adrenergic agonists, which belong to class B. In general, the lowest effective dosage of medication should be used. Systemic absorption can be reduced by punctal occlusion, eyelid closure, and blotting the excess drops away during administration. In those patients who need surgery, most local anesthetics may be used safely because they have not been shown to be teratogenic in humans. Antifibrotic agents commonly used adjunctively in trabeculectomy, however, should be avoided. Glaucoma laser procedures, such as laser peripheral iridotomy and laser trabeculoplasty, have been employed without identifiable teratogenic effects or increased risk of side effects for pregnant women.