Pregnancy toxicosis and eye changes

If pregnancy proceeds normally, there are no changes in the retinal vessels. As an exception, angiospasm and hyperemia of the optic nerve disc are sometimes observed without a decrease in visual acuity.

In early toxicosis of pregnancy, various types of retinal angiopathies are observed (varicose veins, narrowing of arteries, tortuosity of individual arterioles, hyperemia of the optic nerve head), retinal hemorrhages and retrobulbar neuritis may occur.

One of the forms of late toxicosis of pregnancy is nephropathy of pregnancy, which mainly affects the vascular system and kidneys and is characterized by edema, arterial hypertension and proteinuria. Vascular disorders are detected primarily during examination of the fundus: narrowing of the arteries and dilation of the veins, edema of the retina and even retinal detachment are noted. Unlike hypertension, with spasm of the retinal arteries due to toxicosis of pregnancy, there is no compression of the veins at the sites of arteriovenous crossings.

A severe form of late toxicosis of pregnancy is eclampsia, characterized by the sudden onset of convulsions and loss of consciousness. Symptoms of nephropathy of pregnancy (edema, arterial hypertension, proteinuria) are accompanied by excruciating headache, a feeling of heaviness in the head, dizziness, individual visual hallucinations, depressed mood, anxiety, lethargy, adynamia, visual disturbances (flickering spots, fog, veil before the eyes, deterioration of vision up to its short-term loss), memory impairment, nausea, vomiting, diarrhea, puffiness of the face, cyanosis of the skin and mucous membranes. Eclampsia is especially severe in cases of concomitant somatic diseases (hypertension, chronic glomerulonephritis and pyelonephritis, diabetes mellitus), as well as in women who have had encephalitis, meningitis, hepatitis, rheumatic heart disease. As eclampsia progresses, dysfunctions of vital organs increase, leading to cerebral hemorrhages, retinal detachment, retinal hemorrhages, neuroretinopathy with loss of vision, renal, hepatic and respiratory failure.

All treatment measures are aimed at eliminating generalized vascular spasm, hypovolemia, reducing blood pressure, combating intoxication, improving microcirculation, etc. Monitoring of diuresis, breathing, vision, and the state of the cardiovascular system is mandatory. If intensive therapy is ineffective, a cesarean section is performed. One of the indications for its implementation is retinal hemorrhage, retinal detachment, and neuroretinopathy. Particular attention should be paid to women with high myopia and peripheral vitreoretinal dystrophies (lattice, cystic, cobblestone, pigmented), since in these cases there is a risk of retinal detachment during natural childbirth. Argon prophylactic laser coagulation allows many pregnant women to avoid cesarean section.