Eyes During Pregnancy: Normal Changes and Warning Signs

Pregnancy brings profound changes in hormones, fluid balance, blood volume and the immune system, and the eyes are not exempt. Many pregnant women notice slightly blurred vision, drier eyes or that their contact lenses suddenly feel uncomfortable. Most of these changes are harmless and temporary, settling within weeks to months after birth or the end of breastfeeding.

However, some visual symptoms in pregnancy are important warning signs, especially of pre-eclampsia, a serious blood pressure condition. Women with diabetes also need close eye monitoring because pregnancy can accelerate diabetic retinopathy. This guide explains what is normal, what needs urgent attention, how to approach eye medicines safely, and why laser eye surgery should wait.

Why pregnancy affects the eyes

Hormones such as oestrogen, progesterone and relaxin, along with increased fluid retention and changes in blood circulation, affect many tissues in the eye:

• The cornea can retain fluid and become slightly thicker and more curved, changing your prescription a little.
• The tear film may become less stable, leading to dryness.
• Eye pressure typically falls slightly during pregnancy, which can be helpful for women with glaucoma.
• Blood vessels respond to changes in blood pressure, which is why high blood pressure disorders can affect the retina.
• The immune system changes, so some inflammatory eye conditions improve while others may flare.

Normal changes during pregnancy

Because the prescription can fluctuate, many eye care professionals suggest delaying non-urgent changes to glasses until a few months after delivery, unless your vision affects safety, for example when driving. Our article on vision changes during pregnancy discusses these in more detail.

Warning signs: pre-eclampsia and other urgent problems

Pre-eclampsia is a condition that usually develops after 20 weeks of pregnancy, or shortly after birth, and involves high blood pressure and signs of damage to organs such as the kidneys or liver. It can be dangerous for both mother and baby. Visual symptoms are a recognised warning sign, because high blood pressure and swelling affect the retina, optic nerve and visual areas of the brain.

Other uncommon but serious eye problems in pregnancy include:

• Serous retinal detachment in severe pre-eclampsia, which usually resolves once blood pressure is controlled and the baby is delivered.
• Central serous chorioretinopathy, fluid under the retina causing blurred or distorted central vision, which is more common in pregnancy and usually resolves after delivery.
• Idiopathic intracranial hypertension, raised pressure around the brain causing headaches and visual disturbance, which may worsen in pregnancy.
• Cerebral venous thrombosis and pituitary changes, rare causes of headache and visual loss in pregnancy and after birth.

Any sudden change in vision in pregnancy deserves prompt assessment. It is far better to be checked and reassured than to wait.

Diabetes and the eyes in pregnancy

Pregnancy can cause diabetic retinopathy to develop or progress faster in women with pre-existing type 1 or type 2 diabetes. Factors that increase the risk include longer duration of diabetes, existing retinopathy, high blood pressure and rapid tightening of blood sugar control early in pregnancy.

Screening recommendations

• Ideally, have a retinal examination before conception if you are planning pregnancy.
• Have retinal screening early in pregnancy, typically in the first trimester or at the first antenatal visit.
• Further screening later in pregnancy is usually recommended; the NHS diabetic eye screening programme, for example, offers an additional check at around 28 weeks, and more often if retinopathy is found.
• Retinopathy found during pregnancy is usually followed up after birth as well.

Gestational diabetes, which develops during pregnancy, does not usually cause diabetic retinopathy during that pregnancy, so routine retinal screening is generally not required for it. It does, however, increase the long-term risk of type 2 diabetes, so continued health checks are important.

Eye medications during pregnancy and breastfeeding

Eye drops are absorbed into the bloodstream in small amounts, mainly through the tear duct into the nose. Most are considered low risk, but some need caution. The decision should always be made by your doctor, who weighs the benefit of treatment against potential risks.

To reduce how much of a drop is absorbed into your body, close your eyes and press gently on the inner corner of the eye for one to two minutes after applying it. Our guide to eye drops and how to use them explains the technique. Women with glaucoma who are planning a pregnancy should discuss their treatment with their eye specialist in advance, as laser treatment or medication changes may be considered.

Contact lenses and eye make-up

Contact lenses can generally be worn throughout pregnancy, but many women find them less comfortable. Reduce wearing time, use lubricating drops approved for lens wear and keep glasses as a backup. If your lenses no longer fit comfortably, a refit may be needed, though changes often reverse after birth. Maintain strict lens hygiene, as dry eyes are more vulnerable to infection. See our contact lenses guide for safe wearing practices.

Make-up products remain safe to use, but hormonal changes can make the skin and eyes more sensitive. Replace mascara regularly and remove make-up before sleeping.

Laser eye surgery: timing matters

Laser vision correction, such as LASIK, PRK or SMILE, is not recommended during pregnancy or while breastfeeding. There are several reasons:

• The prescription may be temporarily changed by pregnancy, so the result may be inaccurate.
• Corneal healing may be affected by hormonal changes.
• Medicines used before and after surgery, including steroid and antibiotic drops, are best avoided when not essential.
• Dry eye, a common side effect of laser surgery, is already more likely during pregnancy.

Most surgeons advise waiting until the prescription has been stable for several months after delivery and after breastfeeding has finished. Many clinics suggest at least three to six months, and some recommend longer. If you have recently had laser surgery and become pregnant, follow your surgeon's advice about follow-up and drops. Our comparison of LASIK, PRK and SMILE may help when the time comes.

Pre-existing eye conditions and childbirth

Women with high myopia, previous retinal detachment, glaucoma or keratoconus sometimes worry that pushing during a vaginal delivery could harm their eyes. Current evidence suggests that, in most cases, these conditions alone are not a reason for a caesarean section. The decision is made individually by your obstetric team, sometimes with input from an eye specialist. Share your eye history with your maternity team early in pregnancy.

Looking after your eyes during pregnancy

• Attend antenatal appointments, where your blood pressure and urine are checked for signs of pre-eclampsia.
• Keep up with routine eye tests; dilation drops for examination are usually acceptable when needed.
• Eat a balanced diet rich in vegetables, fruit, fish low in mercury and other sources of omega-3; follow local advice about vitamin A, as high-dose supplements should be avoided in pregnancy.
• Rest your eyes with screen breaks and stay well hydrated.
• Sleep as well as you can, and use cool compresses for puffy eyes.
• Wear sunglasses with UV protection outdoors; this also helps reduce melasma.

After the birth

Most pregnancy-related eye changes settle within a few weeks to months after delivery, though some women notice dryness continuing while breastfeeding. Pre-eclampsia can occur up to several weeks after birth, so visual symptoms with headache in the postnatal period also need urgent assessment. Once your eyes have settled, an eye test can confirm whether your prescription has returned to its previous level.

When to see a doctor

Mention any eye changes at your next antenatal appointment or book an eye test if blurring or discomfort persists. Some symptoms, however, should never wait.