Patients with dry eye symptoms can sometimes feel a worsening of symptoms during their pregnancy. Some feel better due to hormone changes, but many more feel a worsening.
Prescription eye drops for eye dryness, such as Xiidra and Restasis and of course steroid, are Category C for pregnant patients, which means there is not enough information about the dangers of these medications on the formation of the early fetus/baby.
Thus, we recommend switching to Autologous Serum or Platelet Rich Plasma if dry eye symptoms worsen during pregnancy and the patient really feels like they need something stronger than non-preserved artificial tears.
Autologous Serum or Platelet Rich Plasma are generally very safe. I have not seen a complication from their use to date. They do need to be frozen/refrigerated according to standard protocols. They cannot be left in the purse to be used as needed in general as most often they are made without preservatives: which I think is the best way to have them made.
The come in bottles like the below and look like yellowish fluid.
Anyone who uses these should be aware of risk of infection and should let their eyeMD know asap if they have worsening discharge or pain.
Steroids also are not recommended during pregnancy given the potential risks to the developing baby.
Thus the safest options for pregant women for dry eye care:
1. Artificial tears: non-preserved are best but preservatives are very unlikely to cause any problem to the fetus/baby.
2. Punctal Plugs
4. Autologous Serum
5. Platelet Rich Plasma
6. Cord Blood Serum
7. Scleral Lenses
Safety of Use in Pregnancy has NOT been established with below but is likely safe but needs to be discussed with Neonatologist or OB before having done:
1. Lipiflow
2. TrueTear
Would AVOID if Pregnant until future prospective, randomized studies are performed.
1. Steroid drops/ointment
2. Xiidra
3. Restasis