Is it safe to stop glaucoma eye drops (e.g. timolol) during pregnancy, given a history of detached retina and a prosthetic eye?

Management of Glaucoma Eye Drops During Pregnancy

The decision to stop glaucoma eye drops during pregnancy should not be automatic—it requires careful assessment of which eye needs treatment, the severity of glaucoma, and selection of safer medication alternatives rather than complete cessation. 1

Critical Context: Which Eye Requires Treatment?

Since you have a prosthetic right eye (from detached retina), the key question is whether your left eye has active glaucoma requiring treatment. A prosthetic eye does not have functional vision or intraocular pressure concerns, so drops would only be needed for the remaining functional eye. 1

The Core Clinical Dilemma

Managing glaucoma in pregnancy involves balancing glaucoma progression risk against fetal safety—this is an interdisciplinary decision, not a blanket "stop everything" approach. 1

Risk Assessment Framework:

• If your functional eye has mild glaucoma with stable visual fields: Temporary discontinuation or reduction may be reasonable during first trimester 2, 3
• If you have moderate-to-severe glaucoma with documented progression: Continuing treatment with safer agents is typically warranted to prevent irreversible vision loss 1, 3, 4
• The risk of permanent blindness from untreated glaucoma must be weighed against theoretical fetal risks 2, 3

Medication Safety Profile in Pregnancy

FDA Pregnancy Categories (Historical Classification):

Beta-blockers (like timolol) are Category C but remain the most commonly used class during pregnancy due to long-term clinical experience. 1, 5 The FDA label for timolol notes no evidence of fetal malformations in animal studies at doses up to 7,000 times the human ophthalmic dose, though delayed fetal ossification occurred at very high doses. 6

Brimonidine is Category B (theoretically safer based on animal data) and is often preferred for first and second trimester. 1 However, it must be discontinued in late third trimester due to risk of central nervous system depression and apnea in newborns. 1, 2

Prostaglandin analogs (like latanoprost) are Category C—most ophthalmologists avoid them due to theoretical risk of premature labor, though limited human data (11 patients) showed no adverse effects. 1

Carbonic anhydrase inhibitors are Category C; topical forms may be considered, but oral forms show teratogenicity in animals at high doses. 1

Practical Medication Strategy:

• First/Second/Early Third Trimester: Brimonidine is generally preferred first-line 2
• Late Third Trimester: Switch from brimonidine to topical carbonic anhydrase inhibitors or low-dose beta-blockers 2
• Throughout pregnancy: Beta-blockers remain an option when benefits outweigh risks 1, 5

Non-Pharmacological Alternatives

Laser trabeculoplasty (ALT or SLT) can be performed safely in all trimesters and should be strongly considered as an alternative to medications. 1, 2, 7 This avoids systemic drug exposure entirely while providing effective IOP reduction. 1

Selective laser trabeculoplasty has been employed without identifiable teratogenic effects or increased risk of side effects for pregnant women. 7

Minimizing Systemic Absorption

If medications are used, systemic absorption must be minimized through punctal occlusion, eyelid closure for 2-3 minutes after instillation, and blotting excess drops. 7 This technique significantly reduces drug exposure to both mother and fetus.

Common Pitfalls to Avoid

• Assuming all glaucoma medications must be stopped: This oversimplifies a complex risk-benefit analysis and may lead to preventable vision loss 3, 4
• Not considering laser trabeculoplasty early: This safe alternative is often underutilized 2, 7
• Continuing brimonidine into late third trimester: This poses real risk of neonatal apnea 1, 2
• Failing to involve obstetrics: This requires coordinated care between ophthalmology and obstetrics 1, 3, 4

Recommended Action Plan

You should immediately schedule a comprehensive glaucoma evaluation to assess:

• Current IOP and optic nerve status in your functional eye
• Visual field stability and rate of any prior progression
• Whether laser trabeculoplasty is appropriate as medication alternative
• If medications are necessary, which agent offers the best risk-benefit profile at 10 weeks gestation

Do not simply stop treatment without this assessment—uncontrolled glaucoma can cause permanent, irreversible vision loss that affects your quality of life far beyond pregnancy. 3, 4