Unfortunately, there is very little data available for the use of eye drops during pregnancy and lactation. In fact, most of the information we have is about the systemic use of the drug, that is, in the form of tablets or syrups or even injections.
So, in case you are pregnant, or breastfeeding, please do remember to tell your doctor that. Most of the drugs mentioned in this second part of the article on the use of eye drops during pregnancy and lactation, are used for a short while. Also, the dosage in eye drops is much lesser than that in oral medication. This means the blood levels of the drug are also much lesser, often not even detected. However, this is what you must know about the safety of various eye drops during pregnancy.
Once again, remember the cardinal rules about the use of eye drops during pregnancy and lactation.
• Use only when necessary and under strict medical supervision, and for the duration prescribed.
• Perform punctual occlusion to decrease systemic absorption of the drug.
Anti-allergy eye drops
Antihistamines
The four eye drops in this class are alcaftadine, azelastine, emedastine and epinastine. Antihistamines given systemically are considered safe in pregnancy and lactation. Therefore, they are safe as eye drops too.
Antihistamine-mast cell stabilizers
Similarly, there are no human eye data for bepotastine, ketotifen, and olopatadine. However, since peak blood concentrations achieved after using eye drops are very miniscule, these drugs may be classified as compatible in pregnancy and lactation.
Anti-infectives
Again, in the absence of human eye data, these drugs are considered safe as eye drops during pregnancy and lactation since their systemic formulations are considered compatible.
These include:
Antibiotics
Besifloxacin, Ciprofloxacin, Gentamicin, Gatifloxacin, Levofloxacin, Moxifloxacin, Ofloxacin, Sulfacetamide, and Tobramycin
Antifungal
Natamycin
Antiviral
Ganciclovir, Trifluridine
Corticosteroids
As is true for the other drugs, there is a lack of data for steroid use during pregnancy also. However, given that blood levels are low after instilling eye drops, these drops are also compatible for use during pregnancy and lactation.
NSAIDs
The drugs in this class are bromfenac, diclofenac, flurbiprofen, ketorolac, and nepafenac. Even though there is very little evidence after use as eye drops, the data about plasma concentrations suggests that the risk to the embryo-fetus or a nursing infant are nil. This means that these eye drops are also compatible with pregnancy and lactation.
