Special circumstances with drops: children and pregnancy

Children can be given eyedrops when they have glaucoma, but we must note that brimonidine—and by extension apraclonidine—were associated with severe sleepiness and possibly coma in young kids. These alpha agents should never be given to children under age 8.

While glaucoma is more a disease of older persons, it occasionally occurs in a young woman who is in the child-bearing years. For these ladies, it is important to consider the effects of glaucoma drugs and pregnancy. While a previous generation of pregnant women possibly took prescription pills and drank alcohol during pregnancy, we now try to avoid any chemical influences on unborn children at all. That being said, we are not aware of a single documented example of a glaucoma eye drop that has been shown to cause a birth defect in a child. And, since a number of patients don’t know they are pregnant until the second or third trimester, we’ve seen a lot of healthy babies born to mothers who were taking glaucoma drops through their pregnancies. But, to plan appropriately, if we assume that many couples use contraception, then it only makes sense to decide what to do about your glaucoma drops before stopping contraception. If you wait until the pregnancy test is positive, much of the critical first trimester has already passed and the fetus has already been exposed to the drugs.

3 choices for glaucoma treatment in women who wish to be pregnant

  1. Keep going with the drops to protect Mom’s eyes, and hope that there are no ill effects

  2. Stop the drops during pregnancy and breast-feeding and watch Mom’s visual field testing closely

  3. Switch to laser treatment or glaucoma surgery prior to the pregnancy

Each of these has been the choice of some patients and the decision really must be made on an individual basis. Each can be the best choice for someone. While some national eye doctor groups have made recommendations about some drops being “safer” than others, there are no hard data that one of the eye drop types is safer than the others in this regard.

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