the high rate of spontaneous regression in the postpartum period [50].

Follow-up Guidelines

The American Academy of Ophthalmology has guidelines for the monitoring of pregnant diabetic patients in its Preferred Practice Patterns for diabetic retinopathy [51]. Ideally, pregnant diabetic women should receive an ophthalmologic examination prior to conception and then again in the first trimester. Subsequent exams should be at the discretion of the examiner but at least every 3 months until delivery.

Intraocular Tumors

Uveal Melanoma

The growth of uveal melanomas in pregnancy has been reported [52–54]. Shields et al. reviewed the clinical course of 16 pregnant patients with uveal melanomas [54]. Seven patients were diagnosed with active melanomas at initial presentation and treated immediately. Of the remaining nine patients who had been followed for various lengths of time with suspicious choroidal nevi or dormant uveal melanomas, seven patients demonstrated growth into active melanomas during the course of pregnancy. The histopathology of the tumors in pregnant women was no different than in nonpregnant women. Also, the 5-year survival rate in these women was similar to nonpregnant women with uveal melanomas. The mechanism of tumor growth in pregnancy is not known.

Choroidal Osteoma

There have been several case reports of choroidal osteomas presenting during pregnancy. McLeod described a patient who developed visual blurring during the first trimester of pregnancy due to a juxtapapillary choroidal osteoma [55]. Gass also reported a patient who presented in the ninth month of pregnancy with visual loss due to a choroidal osteoma with an associated choroidal neovascular membrane [56]. The etiology for the exacerbation of the choroidal osteoma during pregnancy is unknown.

Choroidal Hemangioma

The rapid growth of choroidal hemangioma during pregnancy and its subsequent spontaneous regression after delivery have been reported [57].

Ocular Medications

Topical Drops

Topical medications may pass through the placenta or be excreted in breast milk, creating a potential risk to the fetus. Little data has been published regarding the use of topical ophthalmic medications in pregnant or nursing mothers.

There have been no teratogenic effects reported with the use of topical anesthetics [58]. Dilating drops probably should not be used without indication. The systemic use of phenylephrine, atropine, homatropine, and scopolamine has been reported to be associated with minor fetal abnormalities, such as inguinal hernia and club foot [59].

With regards to glaucoma medications, no studies have been performed in pregnant women. All glaucoma medications are category C medications, with the exception of brimonidine and dipivefrin. Category C medications include those for which animal studies have shown adverse effects to the fetus, but no studies in women are present. Category C medications also include those that have not been studied in animals or humans. A case report has been described of a patient using timolol 0.25% during the second and third trimester without adverse effects on the pregnancy [60]. Topical timolol is secreted in breast milk and should be avoided in nursing mothers [61].

Brimonidine and dipivefrin are category B medications. These drugs have been tested in animals and revealed no harm to the fetus. However, no controlled studies have been performed on pregnant women.

In general, all routine and nonessential medications should be avoided during pregnancy. The decision to use medications, with the potential risks and benefits, should be reviewed with the patient. If administration is