Abstract

DO.13.02

Use of ophthalmic medications during pregnancy

Wolfgang E. Paulus
Institute for Reproductive Toxicology, St. Elisabeth Hospital Ravensburg, Academic Teaching Hospital of the University of Ulm, Ravensburg, Germany

Limited data have been published regarding the potential risks of eye medications to the mother and the fetus. Exaggerated caution or even deferment in the treatment of ill mothers-to-be may result in a dramatic worsening of the underlying disease. On the other hand, an inadequate knowledge of the true risks of pharmacological treatment already applied in the early stages of pregnancy, leads to numerous abortions that are inappropriately indicated.
The overall level of evidence for the risk of giving ophthalmic drugs to pregnant women is low. There is a lack of meta-analyses and randomised controlled trials in this area. Most of the available evidence is based on only individual case reports and animal studies.
This presentation should provide physicians with a brief guide on the use of common eye treatments during pregnancy covering five important groups of eye medication: anti-infection preparations, anti-allergy preparations, anti-inflammatory preparations, corticosteroids, and anti-glaucoma drugs. To understand about drugs used in ophthalmology and their adverse effects during pregnancy, we must examine the physiology and anatomy of the eye and the pharmacokinetic profiles of these drugs. The corneal epithelium acts as a barrier to the penetration of topical drugs into the eye. Absorption of drugs depends on their solubility. To balance the adequacy of drug penetration and the risk of systemic absorption, patients should be instructed to apply only one drop of topical eye medication at one time per squeeze of a bottle. Drug administered topically will drain into the nasolacrimal duct and be absorbed through the epithelial mucosa lining into the systemic circulation.
As a general rule, drugs should be avoided if possible in the first trimester, because the risk of drug-induced fetal teratogenicity is highest during this period than during any other time. Nevertheless, the fear of uncertain drug teratogenicity should not discourage doctors from prescribing treatments when their expected benefits to the mother are thought to outweigh the risk to the fetus. When planning pharmacological treatment in a pregnant woman, well tried and tested substances should be given preference over new drugs. If a pregnant woman has been exposed to an insufficiently tested substance as a result of ignorance of her pregnancy, centers with appropriate data banks (e.g. www.reprotox.de) should be consulted.

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