Should I let the eye doctor know if I am, or am planning to become pregnant?

Yes. Many medicines are known to have adverse effects during pregnancy; others are known to be safe, but in a large number of cases there is no firm evidence to decide on risk or safety.

The most important thing, if you are pregnant or trying to conceive, is to consult your GP and eye specialist about the pressure lowering eye drops which you are taking. Your doctor will balance the potential benefits of medical treatment against any possible risks, so that you can decide on your treatment together. Your ophthalmologist may advise an alternative, as it is important that glaucoma treatment is not discontinued.

As drug molecules are comparatively small, they pass easily through the placenta from the mother into the baby's bloostream. However, the quantity of drug delivered in an eye drop is very small when compared with the amount in a tablet. Drug molecules also pass into breast milk, especially those which dissolve easily in fat. Drugs in breast milk may theoretically cause hypersensitivity in the baby even when concentrations are too low for a pharmacological effect.

The eye drops and tablets listed below may have effects on the developing baby during pregnancy or breast feeding and the use of any of these should be discussed with your doctor.

Beta Blockers pass into the breast milk but adverse effects on the baby are unlikely from normal eyedrop doses. The usual ones prescribed are Timoptol, Teoptic, Betagan, Betoptic. These are also available without preservative in single dose containers, as well as Metipranolol Minims and Nyogel.

Carbonic Anhydrase Inhibitors pass into the breast milk and may reduce the milk supply. They may be in the form of acetazolomide (Diamox) tablets or slow release capsules, or dichlorophenamide (Daranide) tablets. Eye drops of dorzolamide (Trusopt) are also available. Their side effects, due to a general absorption, appear to be very much less than when the tablet form is taken by mouth.

Brinzolamide (Azopt) should not be used during pregnancy unless clearly necessary. It is also strongly recommended that the use of Azopt is avoided when breastfeeding.

Sympathomimetics - Adrenalin (Eppy, Propine or Simplene): Theoretically these eye drops could cause an increased heart rate in the infant during breast feeding.

Miotics (Pilocarpine): There is no evidence of risk to the baby during pregnancy at the doses used for chronic glaucoma. The drug passes into breast milk but adverse effects on the baby are unlikely.

Prostaglandins - Xalatan (latanoprost), Xalacom (combination of latanoprost & timolol), Lumigan (bimatoprost) and Travatan (travaprost): None of these are to be used unless clearly necessary.

Alpha 2 Agonist - Brimonidine (Alphagan): The safety of use during pregnancy or breastfeeding has not been established in humans and this should only be used if the potential benefit justifies the potential risk to the foetus or infant. It is not known if Alphagan is excreted in human milk and therefore caution should be exercised since it has been found to be excreted in animal milk.

As a general rule, drug research cannot be carried out in women who are, or might be, pregnant or breast feeding and as a result, the drug manufacturers for legal reasons cannot recommend the use of drugs in such people.