Treatment of neuro-ophthalmic disorders in pregnant women

This article published in the December issue of the Journal of Neuro-Ophthalmology reviews the management of pregnant women with neuro-ophthalmic disorders. The author, Kathleen B. Digre, MD, explains that the physiological changes that occur during pregnancy increase the frequency of vascular conditions, including retinal artery occlusion, spontaneous orbital hemorrhage and pituitary apoplexy. She emphasizes the importance of accurate neuro-ophthalmic diagnosis in pregnant woman using whatever tests are needed, and concludes that taking optimal care of the mother will usually result in the best care for her baby.

The author discusses that all physiological changes during pregnancy are mediated by the fetus and placenta, and are designed to optimize development in utero and facilitate a safe birth. However, some of these changes can affect the eye and brain. She says that evaluation should proceed as it would if the patient were not pregnant, since correct diagnosis and treatment of the mother should result in the best care for the fetus.

She says that papilledema during pregnancy may signal cerebral venous sinus thrombosis or idiopathic intracranial hypertension. Manifestations of severe preeclampsia and eclampsia include choroidal infarction, serous retinal detachment and disorders of higher cortical function, such as alexia, simultanagnosia and cerebral blindness. Cranial neuropathies have also been reported among pregnant patients. Transient Horner syndrome may occur during the postpartum period.

The author adds that optimal treatment of the neuro-ophthalmic complications of pregnancy requires an understanding of the risks of medications. In some cases, simple aspirin (FDA class C) is prescribed, while in others, prophylactic anticoagulation with heparin or heparinoids (FDA class B) is indicated. Warfarin (FDA class X) generally is avoided because of associated fetal malformations and abnormalities resulting from concurrent fetal anticoagulation.