TREATMENT OF GLAUCOMA IN PREGNANCY

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(Date of issue: January 2021, Version: 3)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on treating glaucoma in pregnancy is available at www.medicinesinpregnancy.org.

Summary

Glaucoma is a disorder of the eye characterised by loss of visual field and optic nerve damage. Usually glaucoma is associated with raised intra-ocular pressure but in some cases intra-ocular pressure may be within normal limits. Primary open-angle glaucoma (chronic simple glaucoma), the most common form, is asymptomatic and the patient may present with gradual visual field loss. Primary angle-closure glaucoma (acute closed-angle glaucoma) is a medical emergency occurring where the flow of aqueous humour into the anterior chamber is blocked.

Pharmacological treatments which reduce the intraocular pressure include ocular beta-adrenoceptor blocking drugs, prostaglandin analogues, miotics, sympathomimetics, and ocular and systemic carbonic anhydrase inhibitors.

There are little or no data on pregnancy outcomes following the use of these medications in pregnancy, therefore an evidence-based assessment of risk to the developing fetus with maternal exposure is not possible. However, untreated or under-treated glaucoma could potentially lead to maternal loss of vision, and as the potential benefits gained from treatment are likely to outweigh any unknown increase in risk to the fetus, optimum treatment of maternal glaucoma in pregnancy should be offered and this risk-benefit analysis discussed with the patient. 

Exposure to medications licensed in the UK for the treatment of glaucoma at any stage in pregnancy would not usually be regarded as medical grounds for termination. Due to the lack of data, reporting of exposure to UKTIS is advised. Additional fetal monitoring may be warranted in individual cases and where other risk factors which independently increase the risk of adverse pregnancy outcome are present. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.