Ocular manifestation of pregnancy and labour: from the innocuous to the sight threatening TOG 2020

Question 1

What proportion of pregnancy reports myopia (more short sited in pregnancy)

Answer 1

14%
Blurred vision, worse for distance

→ Optometrist

Question 2

How long after pregnancy until refractive surgical procedure?

Answer 2

12 months

Question 3

How to prevent systemic absorption of eye drops in pregnancy or breastfeeding?

Answer 3

Pressure on lacrimal punctual for 2 mins, selected cases punctual plugs can be inserted

Question 4

Which dilating eye drops to use if pregnancy?

Answer 4

Avoid phenylephrine

Give topic amide, cyclopentolate.

Question 5

When should retinal screening be performed on women with pre-existing diabetic eye disease

Answer 5

At booking and 28 weeks
Repeat 16-20 if initial screen abnormal

If severe non proliferative to proliferative diabetic retinopathy - more frequent eye examination should be informed

Question 6

Is diabetic retinopathy a CI for vaginal delivery

Answer 6

No

Question 7

Progression of retinopathy in pregnancy if at booking
- Little no retintopathy
- Mod-severe nonproliferative retinopathy

Answer 7

• Mild 10-20%
• Mod-severe 55%

Question 8

Other risk factors for developing or progression of retinopathy during pregnancy?

Answer 8

Duration of diabetes
High HbA1x
Advanced level of diaebtic eye disease

Question 9

If severe NPDR Dx during pregnancy, how long should be followed up baby opthalmolgy

Answer 9

6 months

Question 10

What treatments for proliferative retinopathy can be performed in pregnancy

Answer 10

Retinal laser treatment, rarely causes vitreous haemorrhage

Can clear spontaneously and vitrectomy can be delayed until after delivery

Question 11

What treatments for diabetic maculopathy can be offer, what should be avoided

Answer 11

Can offer
- Laser photocoagulation
- intravitreal steroid

• avoid anti-VEGF agents

Question 12

How long after anti-VEGF should wait before pregnancy?

Answer 12

3 months

Question 13

How common is pregnancy related HTN

Answer 13

11%

Question 14

Does SBP or DBP correlate more closely to changes in fundus

Answer 14

DBP

Question 15

What is Central serous chorioretinopathy (CSCR)

Answer 15

characterised by localised serous detachment of the neurosensory retina at the macula, secondary to leakage from the choriocapillaris from one or more hyper-permeable retinal pigment epithelium (RPE) sites.

Question 16

How common is Central serous chorioretinopathy (CSCR) in pregnancy

How does it present

Answer 16

0.008%

CSCR presents with micropsia (images appear smaller), metamorphopsia (image distortion), or blurred vision. It is most common during the third trimester.

Question 17

Which test to perform if suspect

Answer 17

Amsler grid

refer to ophthalmology

Question 18

What visual loss is seen enlarge with pituitary adenomas

Answer 18

Bitemportal hemianopia

Question 19

What is pituitary apoplexy
How does it present

Answer 19

Ischaemia, thrombosis and bleeding from pituitary gland due to increaserd intracapsular pressure within sella turcica

Severe ‘thunderclap’ headahce with visual disturbance

Question 20

When eye findings in idiopathic intracranial hypertension?

Answer 20

Papilloedema
Unilateral or bilateral 6th nerve palsy

Question 21

Treatment IIH

Answer 21

MDT, weight loss
Oral acetazolamide

Question 22

How common is subconjuctival haemorrhage following delivery>

Answer 22

10%