Pregnant Patient

[Deepak]

Hi, it's me agaim!

What precautions must opticians take when dealing with pregant patients visiting for sight test like-

Can ou use auto refrators on them?

Can u use dilating eye drops on them?

Thanx for your opinions! Deepak.

[Jacqui]

I'm not only an optician but also a RN/Midwife and would advise you to proceed with some caution. Autorefractors, etc. should be OK. I would be very, very careful with any chemicals including dilating drops. Pregnant women can be strange ceatures and no two are alike. Just be CAREFUL !!!!!

[Johns]

Jacqui,

You could leave the "pregnant" part out, and still have a true statement !:D

[Joann Raytar]

Hope this link helps:

http://optom.tripod.com/pregnancy_and_the_eye.htm

Ophthalmic Medications in Pregnancy

Little is known of the effect of ophthalmic medications on pregnancy, foetal well being, and breast milk contamination. However, the National Registry of Drug-Induced Ocular Side Effects (USA) published a comprehensive review of their findings, which are summarised below.

Glaucoma medications

· Beta-blockers (eg. timolol, levobunolol, betaxolol, Carteolol) should be avoided or used in the lowest possible dose in the first trimester of pregnancy and be discontinued 2-3 days prior to delivery to avoid beta-blockade in the infant. Because of case reports of beta-blockers being concentrated in breast mild, they should be avoided in mothers who are breastfeeding.

· Topical and systemic carbonic anhydrase inhibitors (eg. acetazolamide, dorzolamide, brinzolamide) are contraindicated during pregnancy because of potential teratogenic effects. They should not be used in mothers who are breastfeeding because of the potential hepatic and renal effects to the infant.

· Miotics (eg. pilocarpine, echothiophate, carbachol) appear to be safe during pregnancy. The toxicity during lactation is unknown. One exception is demecarium, which is toxic and is contraindicated in pregnancy and mothers who are breastfeeding.

· Prostaglandin Analogs (eg. latanoprost), although not well studied, may be used during pregnancy only if the potential benefit justifies the potential risk to the foetus. Moreover, caution should be exercised when latanoprost is administered in women who are breastfeeding.

· In animal studies, adrenergic agonists (eg. brimonidine) have not demonstrated any foetal risk. Although no studies were conducted in pregnant patients, it may be used if necessary. Whether brimonidine is excreted in human milk is not known.

Mydriatics

· Use of occasional dilating drops during pregnancy for the purposes of ocular examination is safe. However, repeated use is contraindicated because of potential teratogenic effects of both parasympatholytics (eg. atropine) and sympathomimetics (eg. epinephrine). Because of either the anticholinergic or hypertensive effects on the foetus, use of mydriatics is contraindicated in mothers who are breastfeeding.

Corticosteroids

· Although systemic corticosteroids are contraindicated in pregnancy, there are no known teratogenic effects of topical steroids. Because little is known about the risk of topical corticosteroids during lactation, it should be avoided in mothers who are breastfeeding.

Antibiotics

· Two antibiotics that are known to be safe during pregnancy are erythromycin and polymyxin B. During lactation, polymyxin B and sulphonamides have been shown to be safe. Known antibiotics that should be avoided include chloramphenicol, gentamicin, neomycin, rifampin, tetracycline, and tobramycin.

Antivirals

· All antivirals should be avoided during pregnancy because of teratogenic effects. Moreover, they should be avoided in mothers who are breastfeeding because of tumorigenicity.

Fluorescein

· No known teratogenic effects of fluorescein during pregnancy exist. The effect of fluorescein in mothers who are breastfeeding is unknown.

Topical anaesthetic

· No known contraindications exist to the use of topical anaesthetic drops in pregnancy or in mothers who are breastfeeding.

[mrba]

Also note the Rx you get off of the auto refrator may not be stable...

[igirl]

Everyone may already know this, but speaking from experiance, my eye sight was pretty weird when I was pregnant (as well as everything else!) Being in the industry, I could afford getting new lenses a couple of times, but found my eyesight returned to the original RX after my little angel was born.

[Deepak]

thanx y'all 4 importanyt information.:)

[Optom]

Hello,

When instilling eye drops if possible press your index figure (with small cotton bulb) on the fleshy bump you feel at the corner of the nose where eyelid begins. This minimizes the amount of medication draining into the nose, where it can be absorbed into the circulation.
Remember, patients with asthma or other types of breathing problems, heart irregularities, depression, or allergic to medication may in rare instances develop severe reactions as a direct consequence of use of certain eye drops.

Best regards,

Optom