Pregnancy brings an enormous number of changes to the body, and for people living with glaucoma, those changes can have real implications. Eye pressure often drops naturally during pregnancy, but that doesn’t guarantee smooth sailing if you already have glaucoma. And when treatment is needed, choosing the safest option becomes much more complicated.

If you’re pregnant (or planning to be) and living with glaucoma, this guide can help you prepare for a thoughtful, informed conversation with your eye doctor, OB-GYN, and care team. *

Why Eye Pressure Changes During Pregnancy

Many pregnant patients experience a natural drop in intraocular pressure (IOP) starting around 18 weeks, often 1–4 mm Hg below baseline. That pressure usually returns to normal about six weeks after delivery.

Researchers aren’t entirely sure why. Theories include:

• Hormonal changes increasing fluid drainage
• Lower episcleral venous pressure
• Increased corneal thickness that affects measured pressure

These changes do not mean new glaucoma usually develops during pregnancy, but they can influence how well your existing glaucoma stays controlled.

If You Already Have Glaucoma: Your Pressure May Go Up — or Down

Studies show a mixed picture:

• Some pregnant patients with ocular hypertension experience a 24% drop in IOP, sometimes returning to normal levels.
• Others, especially those on multiple glaucoma medications before pregnancy, may see sharp pressure rises, sometimes before the third trimester.
• Nearly half of patients with established glaucoma may experience an IOP increase of at least 5 mm Hg during pregnancy.

Because of this variability, experts stress close monitoring, especially if you’re young or have secondary glaucoma types like uveitic glaucoma, steroid-induced glaucoma, or pigment dispersion.

Why Treating Glaucoma During Pregnancy Is Complicated

Treating glaucoma in pregnant patients is challenging for two reasons:

1. We have very little high-quality research.
   Most available data comes from small case reports or animal studies using drug doses far higher than what humans would receive.
2. Medication safety is uncertain.
   Many glaucoma drops are labeled under older FDA pregnancy categories, most as Category C, meaning risk is unknown and caution is needed.

Because of this, treatment plans must be customized, balancing risk to the baby with the real danger of vision loss if glaucoma isn’t controlled.

What We Know About Medication Options During Pregnancy

Glaucoma medications during pregnancy need to be used cautiously because research in humans is limited, and most drops fall into a category where potential fetal risks are unknown. In general, brimonidine is often considered the safest early in pregnancy, while beta blockers like timolol may be used later but at the lowest dose possible and often avoided in the first trimester. 

Prostaglandin analogues are usually avoided because they may trigger uterine contractions, and other drops (like carbonic anhydrase inhibitors or rho-kinase inhibitors) are only used when the benefits clearly outweigh the risks. 

Regardless of the medication, doctors aim to minimize exposure by using the lowest effective dose and techniques like punctal occlusion.

When Drops Aren’t Enough: Is Surgery Safe?

Surgery is complicated during pregnancy:

• Filtration surgeries have higher failure rates because antimetabolite use (like MMC or 5-FU) is unsafe
• Positioning and anesthesia pose additional risks
• Post-op medications may not be pregnancy-safe

Because of this, experts often recommend:

Selective Laser Trabeculoplasty (SLT)

A strong option during pregnancy because it:

• Reduces drop burden
• Avoids systemic medication exposure
• Can delay or eliminate the need for surgery

If surgery is absolutely required, minimally invasive glaucoma surgery (MIGS) under topical anesthesia is preferred.

The Bottom Line: Pregnancy Is High-Risk, But Temporary

Most people with glaucoma can be managed safely with close monitoring, the careful use of lower-risk medications when needed, and treatments like laser therapy to reduce dependence on eye drops. Success during this period depends on strong team-based care, with your ophthalmologist coordinating closely with your OB-GYN, pediatrician, and, when needed, a glaucoma specialist to protect both your vision and your baby’s health.

* Cleveland Clinic (November 20, 2025). “Managing Glaucoma in Pregnant Patients” clevelandclinic.org

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