Dry Eye in Pregnancy and Breastfeeding

Key overview

  • Heat and lid hygiene are mechanical, involve nothing absorbed, and are the reasonable first-line choice.
  • Every supplement and every medicated drop should be cleared with your midwife or doctor. Do not start anything on the strength of a webpage.
  • Contact lens intolerance in pregnancy is common and usually temporary. Do not buy a new prescription during it.
  • Sudden visual change with headache, swelling or upper abdominal pain needs same-day assessment — that is pre-eclampsia territory.

Dry eye commonly worsens in pregnancy and often settles afterwards. This page is deliberately conservative, because the usual calculus changes when anything you take reaches someone else.

Before anything else

Sudden blurring, flashing lights, or visual disturbance accompanied by headache, swelling of the face or hands, or pain below the ribs is not a dry eye problem. It needs same-day assessment by your midwife, GP or maternity unit. Pre-eclampsia can present with visual symptoms, and this is the one thing on this page that cannot wait.

Ordinary gritty, burning, end-of-day dryness is not that, and the rest of this page is about the ordinary version.

Why it changes

Hormonal shifts in pregnancy affect the lacrimal gland and the meibomian glands, and also alter corneal thickness and curvature slightly. Fluid retention plays a part. The net effect for many people is reduced tear film stability, which shows up as dryness, grittiness and lens intolerance.

It typically improves after delivery, though breastfeeding maintains some of the hormonal picture and symptoms may persist through that period.

What is a conservative choice

Measures that are mechanical or environmental, involving nothing absorbed:

  • Warm compresses and heat applied to closed lids. Nothing enters the body; the mechanism is temperature. See heat therapy.
  • Lid hygiene with warm water and careful technique.
  • Environmental changes — humidifier, redirected airflow, lower monitor, blink breaks.
  • Sleep position and overnight exposure, if symptoms are worst on waking.

These are the ones to start with, and for many people they are sufficient.

What goes through your midwife or doctor

Everything else. Specifically:

  • Lubricating drops. Preservative-free is generally preferred, but confirm the specific product. Do not use anything medicated without asking.
  • All supplements, including omega-3. Omega-3 is commonly recommended in pregnancy, but the product, the dose and whether it contains vitamin A all matter, and that is a conversation rather than a purchase.
  • Any topical oil or cleanser, including castor oil. Castor oil taken orally has historically been used to induce labour, which is a different route entirely, but it is reason enough to ask before applying anything new.
  • Anything prescribed for dry eye — ciclosporin, steroids, oral antibiotics for lid disease. These are prescriber decisions in pregnancy.

Nothing on this page overrides advice from the people managing your pregnancy. If this page and your midwife disagree, follow your midwife.

Contact lenses

Intolerance is common and usually temporary. Two practical points: do not buy a new spectacle or lens prescription during pregnancy or the early postpartum period, because corneal changes make the measurement unreliable and it will likely shift back. And if lenses have become uncomfortable, wearing glasses for a period is the low-risk option rather than pushing through. See taking a break.

Afterwards

If symptoms persist well beyond delivery and any breastfeeding, treat it as ordinary dry eye and work through which mechanism is involved. Pregnancy sometimes unmasks a gland problem that was already developing rather than creating one.

Part of our guide to Dry Eye Through Life.