We don’t know enough about is using eye drops during pregnancy and lactation is safe. Avoiding these drugs, therefore, is the best option, especially since they may cause altered growth, structural anomalies, or problems with the baby. However, this may not always be possible. Especially in cases like glaucoma, eye infections, and eye surgery, you will need to use the eye drops during pregnancy and lactation also.
Fortunately, the concentrations in the blood of the eye drops is very low as compared to oral use. Therefore, the risk to the baby may be considered low and the drug classified as compatible in pregnancy and breastfeeding.
Precautions for using eye drops during pregnancy and lactation
If you need eye drops during pregnancy and lactation, your doctor will teach you how to ensure that minimal drug reaches your blood circulation. She will teach you how to do a punctual occlusion. In fact, you should do a punctual occlusion even if you are no pregnant.
Punctal occlusion when using eye drops during pregnancy and lactation
Place your index finger over the angle of your eye, which is the junction between the eye and the nose. Maintain this pressure for about a minute, and then wipe off any excess drug with a facial tissue.
Glaucoma
Glaucoma is a chronic disease in which the eye pressures are higher than normal, and affect the optic nerve. The treatment consists of lowering the eye pressure using medication, lasers or surgery. Here is what you need to know about using glaucoma eye drops during pregnancy and lactation. There is limited data available about the use of glaucoma eye drops during pregnancy and lactation. Here is what we know:
Alpha agonists
There is no data for use of apraclonidine. Brimonidine has one case report in pregnancy and breastfeeding showing no fetal or nursing infant harm. However, your doctor will not give you brimonidine if you are breastfeeding. This drug, however, is considered safe during pregnancy.
Beta blockers
There are two case reports for timolol. One described no fetal harm, while the other reported a growth restriction in the newborn. There is no data for betaxolol, carteolol, levobunolol, and metipranolol,
Miotics
Pilocarpine is by and large considered safe during pregnancy, even though there is no significant data available.
Carbonic anhydrase inhibitors, CAIs
There is one case report of growth restriction in one case treated with fixed combination of dorzolamide and timolol. There is no data on file about brinzolamide.
Prostaglandin analogs
There is no data about three of the prostaglandin analogs, namely, bimatoprost, tafluprost and travoprost. However, data exists for 11 pregnancies exposed to latanoprost. One of these cases was lost to follow-up, there was one miscarriage, and nine newborns without any congenital anomalies.
My personal experience is with two young ladies who continued to use Travoprost for two months of their first trimester, and one who continued to use Bimatoprost has been good. They did not realize they were pregnant, and did not stop the drug until after the pregnancy was confirmed. They are all happy mother of happy, healthy babies.
If you are planning to be, or are pregnant and have glaucoma
- So if you planning a pregnancy, discuss your treatment options with your doctor. She may want to change from your routine glaucoma medication to one that is safer during pregnancy.
- You may want to discuss the option of getting a Selective Laser Trabeculoplasty, a laser procedure which decreases eye pressures, once you decide to plan your pregnancy. The procedure may also be considered when you are pregnant. However, your doctor will discuss its risks and benefits with you. Remember, SLT is not a permanent solution, and you will need to be under constant medical supervision.
- If you have been on glaucoma medication, and find that you are pregnant, there is no reason to panic. Even though here is limited data about the safety of glaucoma medication in pregnancy, you should not worry. Neither you, nor the baby are at any great risk of harm. Discuss the fact that you’ve used your glaucoma medication with your obstetrician and your doctor, and they will both help you understand the implications of the drugs.
- Your doctor will prefer to use beta blockers, alpha agonists and CAIs in the first 8 months of your pregnancy.
- CAIs are the drug of choice in the last month of pregnancy.
- While breastfeeding, your doctor will prefer to give you prostaglandin analogs, or CAIs.
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The best time to instill the eye drop is just after feeding the baby. This way, the time between the eye drop and the next feed is maximum. Since the drug levels in milk are maximum 30-120 minutes after using eye drops, this stands to reason.
- Never forget punctal occlusion because it minimizes the systemic absorption of the drug.
