Pregnancy and Dry Eye

If you developed new dry eye symptoms during pregnancy — or your existing dry eye dramatically worsened — those changes are real, common, and worth addressing. This page covers the mechanisms behind pregnancy-related dry eye, what symptoms to expect, and what treatment options are appropriate during pregnancy and breastfeeding.

How Pregnancy Affects Dry Eye

Pregnancy involves substantial hormonal, immunological, and physiological changes that affect the eyes:

Hormonal Changes

The dramatic increases in estrogen, progesterone, and prolactin during pregnancy affect the lacrimal glands and Meibomian glands. Both are hormonally regulated tissues that respond to the rapidly changing hormonal environment of pregnancy. Many women notice changes in tear film quality and quantity during pregnancy that mirror changes they may have experienced during puberty or menstrual cycles.

Reduced Tear Production

Aqueous tear production often decreases during pregnancy, particularly in the third trimester. The mechanism likely involves changes in lacrimal gland responsiveness to hormonal cues and possibly mild systemic dehydration effects.

Meibomian Gland Changes

The Meibomian glands often show subtle changes during pregnancy, contributing to evaporative dry eye in some patients.

Corneal Curvature and Refractive Changes

Pregnancy can cause small but measurable changes in corneal curvature and thickness. While these usually do not require new glasses prescriptions, they contribute to the perception of changing visual quality that many pregnant women report.

Contact Lens Intolerance

Many women find that contact lenses they previously tolerated comfortably become uncomfortable during pregnancy. This is often a temporary problem that resolves postpartum, but for some women, the changes persist. See our page on contact lenses and dry eye for more.

Postpartum and Breastfeeding

Many women experience continued dry eye symptoms postpartum, particularly while breastfeeding. The hormonal shifts of postpartum and the demands of breastfeeding can prolong dry eye symptoms for many months after delivery.

Symptoms of Pregnancy-Related Dry Eye

• Burning, stinging, or gritty sensation that started during pregnancy
• Contact lens intolerance that emerged during pregnancy
• Eye fatigue, especially with reading or screen use
• Excessive watering (paradoxical tearing)
• Fluctuating vision
• Symptoms that worsen as pregnancy progresses
• Symptoms that persist or worsen during breastfeeding

How We Diagnose Pregnancy-Related Dry Eye

Diagnosis follows the standard comprehensive dry eye evaluation with awareness of pregnancy-specific considerations:

• Symptom and pregnancy history — including trimester, pre-pregnancy symptoms, current trimester progression
• Tear film testing — breakup time, osmolarity
• Meibography — to assess Meibomian gland status
• Schirmer test — to identify aqueous deficiency
• Lid margin examination — for any inflammatory changes
• Ocular surface staining — to assess severity

Treatment Considerations During Pregnancy

Treatment during pregnancy is constrained by safety considerations for the developing fetus. The conservative approach prioritizes interventions with the longest track record of safety:

Preservative-Free Artificial Tears

The first-line treatment during pregnancy. Preservative-free formulations avoid any potential systemic absorption of preservatives. Lubricating gels and ointments at night are also safe.

Lifestyle and Environmental Modifications

Increased humidification, avoiding direct airflow on the face, omega-3 supplementation (within obstetric guidelines), screen breaks, hydration, and warm compresses are all safe and often helpful.

Lid Hygiene

Standard lid hygiene routines are appropriate. Some specialty lid cleansers should be used cautiously — review with us during your evaluation.

Medications to Avoid or Discuss

Several common dry eye medications require careful evaluation during pregnancy:

• Prescription anti-inflammatory drops (cyclosporine, lifitegrast) — generally avoided during pregnancy unless benefits clearly outweigh risks
• Topical corticosteroids — used only when clearly indicated, in coordination with obstetric care
• Tetracycline-class oral antibiotics (sometimes used for blepharitis) — contraindicated during pregnancy and breastfeeding

Any prescription medication should be discussed with both your eye care provider and your obstetric team.

In-Office Treatments

Treatments like IPL, RF, and LLLT are generally not performed during pregnancy. While there is no specific evidence of harm, the conservative practice is to defer these treatments until after delivery and breastfeeding.

What to Continue During Breastfeeding

Many medications considered cautious during pregnancy can be reconsidered during breastfeeding. Discuss timing with your eye care provider and obstetrician.

When to Address Treatment Postpartum

For many women, pregnancy-related dry eye improves substantially in the months after delivery and after breastfeeding ends. For others, it persists or progresses. A reassessment 3 to 6 months postpartum can identify which patients need ongoing treatment versus which had transient pregnancy-related symptoms.

For patients who had significant dry eye before pregnancy or developed it during pregnancy and have not improved, the postpartum period is an excellent time to address it comprehensively — including with in-office treatments that were deferred during pregnancy.