Serious Visual (Ocular) Complications in Pre-eclampsia and Eclampsia

Complete loss of vision is an uncommon ocular complication of pre-eclampsia/eclampsia. The conditions which lead to visual loss in pre-eclampsia include cortical blindness, retinal detachment, retinal vascular thrombosis and optic nerve atrophy.

The objective was to describe the cause, clinical course and prognosis in blindness complicating pre-eclampsia.

This is a prospective observational study conducted at the Govt. Hospital for Women and Children, Chennai, from January 2006 to December 2010. Sixteen women who were diagnosed with blindness complicating pre-eclampsia were analysed for the cause of blindness, clinical details and prognosis.

The incidence of blindness among women with pre-eclampsia and eclampsia was 0.17%. The cause of visual loss was cortical blindness in 14 patients and retinal detachment in two patients. Blindness manifested predominantly in the intrapartum and postpartum period in 13/16 cases (81.25%). Seven patients (43.75%) suffered from severe pre-eclampsia, and nine patients (56.25%) suffered from eclampsia. HELLP syndrome, gestational diabetes mellitus (GDM) and anaemia were seen in two patients each. Seven patients also presented with motor deficits. CT scan imaging showed cortical vein thrombosis in five cases, arterial infarcts in two cases, widespread hypodense areas in the occipito-parietal region in six cases. In patients with cortical blindness, recovery of vision occurred within 10 days.

Cortical blindness and retinal detachment are rare complications of pre-eclampsia and eclampsia. The prognosis is usually good especially with cortical blindness where the loss of vision is transient. The mainstay of management is effective treatment of pre-eclampsia/eclampsia along with termination of pregnancy.