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Eye manifestations during pregnancy

Eye manifestations during pregnancy. By Dr Mohamed Abusharifa, MD Ophthalmic surgeon Tulkarem - Palestine. TARGET. To highlight those the eye problems, which are related with pregnancy, without interfering into treatment modalities. Eye manifestations during pregnancy.

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Eye manifestations during pregnancy

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  1. Eye manifestations during pregnancy By Dr Mohamed Abusharifa, MD Ophthalmic surgeon Tulkarem - Palestine

  2. TARGET To highlight those the eye problems, which are related with pregnancy, without interfering into treatment modalities

  3. Eye manifestations during pregnancy Ocular changes that occur in pregnancy are usually TRNSIENTin nature, but occasionally there may be PERMANENT disorders Courtesy of: Sunness JS. The pregnant woman’s eye. Surv of Ophthalmology 1988;32:219-38

  4. PLAN • NEURO-OPHTHALMOLOGICAL changes appearing in pregnancy • The effects of pregnancy on PRE-EXISTING ocular disorders • Ocular disorders associated with PREGNANCY-RELATED diseases • Eye changes developingDURING PREGNANCY

  5. BUT BEFORE proceeding into presentation please pay attention to the following 5slides :

  6. 1 nausea + severe vomiting + severe headache+ intracranial disorders in a pregnant

  7. Newborn with hydrocephalus due to congenital toxoplasmosis 2 (From Dubey JP, and Beattie CP. Toxoplasmosis of animals and Man. CRC Press, Baca Raton, Florida, 52, 1988.)

  8. 3 A toxoplasmosis lesionin the center of retina Normal retina Courtesy of KANSKI : Clinical Ophthalmology

  9. 4 Normal retina Diabetic retinopathy Courtesy of KANSKI : Clinical Ophthalmology

  10. NO contact lensesduring pregnancy 5 = X

  11. Now presentation starts: • NEURO-OPHTHALMOLOGICAL changes appearing in pregnancy • The effects on PRE-EXISTING ocular disorders • Ocular disorders associated with PREGNANCY-RELATED diseases • Eye changes developing DURING PREGNANCY

  12. NEURO-OPHTHALMOLOGICAL changes appearing in pregnancy Some of the symptoms which are regarded normalin pregnancy, such as : nausea & vomitingmay be signs ofintracranial disorders Courtesy of: T. Walsh, Neuro-Ophthalmology Clinical Signs & Symptoms

  13. NEURO-OPHTHALMOLOGICAL changes in pregnancy Nausea & severe vomitingshould be considered seriously while doing D.D. in a pregnant having: • Visual disturbances • Persistent headache • Visual field defects • Oculomotor palsies Courtesy of: T. Walsh, Neuro-Ophthalmology Clinical Signs & Symptoms

  14. NEURO-OPHTHALMOLOGICAL cases included in DD during pregnancy: • Pseudotumor cerebri (benign intracranial hypertension) • Prolactinoma (adenoma of pituitary gland) • Venous sinus thrombosis

  15. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: • Pseudotumor cerebri (benign intracranial hypertension) • Prolactinoma (adenoma of pituitary gland) • Venous sinus thrombosis

  16. NEURO-OPHTHALMOLOGICAL changes in pregnancy Typical symptoms & findings: • Blur vision • Headache • Nausea & severe vomiting • 6th nerve palsy • Edema of optic disc Pseudotumor cerebri(benign intracranial hypertension) Courtesy of: T. Walsh, Neuro-Ophthalmology Clinical Signs & Symptoms

  17. nausea + severe vomiting + severe headache

  18. Left Lateral Rectus Muscle palsy due to Left 6th nerve palsy Right Lateral Rectus Muscle palsy due to Righ 6th nerve palsy Courtesy of KANSKI: Clinical Ophthalmology

  19. EDEMA OF OPTIC DISC edema of optic disc Normal optic disc Courtesy of: T. Walsh, Neuro-Ophthalmology Clinical Signs & Symptoms

  20. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: • Pseudotumor cerebri (benign intracranial hypertension) • Prolactinoma (adenoma of pituitary gland) • Venous sinus thrombosis

  21. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: • Pseudotumor cerebri (benign intracranial hypertension) • Prolactinoma (adenoma of pituitary gland) • Venous sinus thrombosis

  22. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: Prolactinoma A noncancerous tumor (adenoma) affecting the pituitary gland that causes increase in the production of the hormone prolactin (LTH)

  23. NEURO-OPHTHALMOLOGICAL changes in pregnancy Prolactinoma Symptoms & findings: • Galactorrhea • Amenorrhea • Fatigue • Decreased libido • Headache • Visual disturbances (due to pressure on the opticnerve) • Visual field defects (due to pressure on the opticchiasm)

  24. Pituitary gland

  25. Pituitary gland pressing on optic chiasm from below

  26. Optic chiasm Optic nerve tip Courtesy of: Dynamic Human Anatomy Student Version

  27. Enlarged sella turcica due to pressure caused by pituitary adenoma

  28. normalVisual field inLeft Eye Pt’s view Courtesy of D. J. Spalton: Atlas of CLINICAL OPHTHALMOLOGY

  29. normal visual field inRight Eye Pt’s view Courtesy of D. J. Spalton: Atlas of CLINICAL OPHTHALMOLOGY

  30. Asymmetric bitemporal visual field loss due to pressure on the optic chiasm & optic nerve from below Courtesy of Visual Fields: Examination & Interpretation Publication of American Academy of Ophthalmology

  31. Pituitary adenoma (prolactinoma) Courtesy of Visual Fields: Examination & Interpretation Publication of American Academy of Ophthalmology

  32. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: Prolactinoma It is recommended that any pregnant with a known pituitary prolactinoma must have regular visual field follow-up to rule out enlargementwhich leads to compression of optic chiasm and causes uncorrected visual field loss Courtesy of Visual Fields: Examination & Interpretation Publication of American Academy of Ophthalmology

  33. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: • Pseudotumor cerebri (benign intracranial hypertension) • Prolactinoma (adenoma of pituitary gland) • Venous sinus thrombosis

  34. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: • Pseudotumor cerebri (benign intracranial hypertension) • Prolactinoma (adenoma of pituitary gland) • Venous sinus thrombosis

  35. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: Venous sinus thrombosis is a form of brain stroke that results from thrombosis of the dural venous sinuses Courtesy of Lanska DJ, Kryscio RL. Risk factors for peripartum & pastpartum stroke& intracranial venous thrombosis. Stroke 2000;31:1274-82

  36. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: Venous sinus thrombosis Increased risk of occurrence in: • Cesarean delivery • Advanced maternal age • Hypertension • Infections Courtesy of Lanska DJ, Kryscio RL. Risk factors for peripartum & pastpartum stroke& intracranial venous thrombosis. Stroke 2000;31:1274-82

  37. Venous sinuses

  38. NEURO-OPHTHALMOLOGICAL casesincluded in DD during pregnancy: Venous sinus thrombosis Signs & symptoms: • Throbbing headache • Focal or generalized seizures • Paresis • Optic disc edema Courtesy of Lanska DJ, Kryscio RL. Risk factors for peripartum & pastpartum stroke& intracranial venous thrombosis. Stroke 2000;31:1274-82

  39. nausea + severe vomiting + severe headache

  40. Venous sinus thrombosis thrombus Courtesy of Lanska DJ, Kryscio RL. Risk factors for peripartum & pastpartum stroke& intracranial venous thrombosis. Stroke 2000;31:1274-82

  41. EDEMA OF OPTIC DISC edema of optic disc Normal optic disc Courtesy of: T. Walsh, Neuro-Ophthalmology Clinical Signs & Symptoms

  42. PLAN • NEURO-OPHTHALMOLOGICAL changes appearing in pregnancy • The effects on PRE-EXISTING ocular disorders • Ocular disorders associated with PREGNANCY-RELATED diseases • Eye changes developing DURING PREGNANCY

  43. The effects of pregnancy on PRE-EXISTING ocular disorders • Diabetic retinopathy • Graves’ disease • Glaucoma • Uveitis

  44. The effects of pregnancy on PRE-EXISTING ocular disorders • Diabetic retinopathy • Graves’ disease • Glaucoma • Uveitis

  45. The effects of pregnancy on PRE-EXISTING ocular disorders Diabetic retinopathy is the most ocular disorder modified by pregnancy Courtesy of Sheth BP. Does pregnancy accelerate the rate of progression of diabetic retinopathy? Curr Diab Rep 2002;2:327-30

  46. The effects of pregnancy on PRE-EXISTING ocular disorders Diabetic retinopathy its progression is affected by : • Duration of DM • Presence of diabetic retinopathy at conception • Sugar control during pregnancy Courtesy of Sheth BP. Does pregnancy accelerate the rate of progression of diabetic retinopathy? Curr Diab Rep 2002;2:327-30

  47. The effects of pregnancy on PRE-EXISTING ocular disorders Diabetic retinopathy • Ophthalmic status should be evaluated before pregnancy • Good sugar control throughout pregnancy • Eye exam every 3 months • Treatment by laser photocoagulation before pregnancy may reduce progression by 50% Courtesy of Sheth BP. Does pregnancy accelerate the rate of progression of diabetic retinopathy? Curr Diab Rep 2002;2:327-30

  48. The effects of pregnancy on PRE-EXISTING ocular disorders Diabetic retinopathy Normal retina Courtesy of KANSKI : Clinical Ophthalmology

  49. The effects of pregnancy on PRE-EXISTING ocular disorders Diabetic retinopathy laser photocoagulation

  50. The effects of pregnancy on PRE-EXISTING ocular disorders • Diabetic retinopathy • Graves’ diseas • Glaucoma • Uveitis

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