There Is Hope For Your Dry Eyes During Pregnancy
Eric D. Donnenfeld, MD
Pregnancy is one of the great life-changing experiences for an individual. Along with all of the hormonal shifts and changes in your body that occur during pregnancy, the changes that occur to your tear film are just as great. The tear film is a complex structure composed of tears, mucin and lipids. When the tear film becomes insufficient to support the surface of the eye due to a lack of production of tears or a decrease in quality of tears, dry eye syndrome occurs.Dry eye syndrome
Dry eye syndrome is one of the most common maladies affecting women. It occurs during periods of hormonal shifts, such as during menopause and pregnancy. This is because the changes in hormones affect tear and lipid production. The same oil glands that cause acne in pregnant women also affect the oil glands in the eyelids and can block the production of lipids and oils that lubricate the eye and prevent the lids from rubbing against the eye with blinking. Birth control pills can also trigger dry eye syndrome, along with a variety of other medications.
Dry eye syndrome is commonly manifested during pregnancy by an increased sensation in the eye -- a feeling of irritation, grittiness, or foreign body sensation, and paradoxically, patients will sometimes complain of tearing. The tearing occurs because the quality of the tear film has broken down, and the irritation to the ocular surface causes a reflex of tear production to lubricate the eye in response to irritation, so that patients with dry eye will complain of too many tears. Some patients will complain of contact lens intolerance. The contact lens floats on the tear film and when the patient's eye is dry, the contact lens grinds against the lids, causing an inability to their lenses.
When does it occur?
Pregnancy-related dry eye usually occurs at the end of the first trimester, and will continue throughout the pregnancy, and very commonly will persist for several months following delivery. This is because the same hormonal shifts are supported during nursing, so that nursing mothers with dry eye may continue to have dry eye syndrome until several months following discontinuation of nursing.
What can be done about it?
Therapy for dry eye during pregnancy should be geared toward improving the quality of the tear film. We frequently will use a transiently-preserved tears, as preservatives can damage the surface of the eye. Many good brands (like Refresh Tears) contain a transient preservative which is inactivated by exposure to sunlight, that can lubricate the eye without causing any preservative toxicity. Your doctor can recommend which brand is right for you. Simply using these kinds of drops four to eight times per day may be all that is required for most patients during pregnancy. In patients who have more severe dry eye, a gel or even an ointment at night can further support the eye and improve symptoms. Check with your doctor to see what is right for you.
I also sometimes recommend hot compresses to help open up the blocked oil glands. The most important concept for the pregnant female to remember is that this is a transient problem, which will almost always completely resolve after delivery.