Appendix
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Obstetrics and Gynecology

Ocular Manifestations of Preeclampsia

Preeclampsia is a disorder that affects pregnant women, most commonly in their third trimester. Characterized by hypertension and proteinuria, it can involve nearly every organ system and often results in significant end-organ dysfunction. Preeclampsia is relatively common in pregnancy, affecting between 3% and 8% of pregnancies worldwide. Visual symptoms occur in up to 40% of affected patients, and the condition can affect multiple parts of the visual pathway. Although the numerous changes that

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Eclampsia is defined by the occurrence of convulsions in a previously preeclamptic woman in the absence of a pre-existing neurologic condition that could account for the seizures.
  • Health care providers should be alert to complaints of acute visual changes in pregnant patients as they can be a presenting sign of significant impending morbidity.
  • Preeclampsia is a disorder that affects pregnant women, most commonly in their third trimester.
  • Retinal arterial and structural abnormalities are identified in 30 to 100% of patients with preeclampsia and eclampsia.
  • Magnetic resonance imaging of the brain also poses no known risk to the mother or fetus and can demonstrate posterior cerebral edema as seen in PRES; it can also reveal the presence of ischemic or hemorrhagic strokes.
  • Retinal angiography most commonly involves the intravenous administration of fluorescein dye and is indispensable in diagnosing retinal vascular disease.
  • Preeclampsia is defined as the first instance after 20 weeks of gestation of systolic blood pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg and proteinuria of greater than 300 mg/day.
  • Symptoms can include decreased vision, diplopia, scotoma, or photopsia.
  • fundus autofluorescence, B-scan ultrasonography, and optical coherence tomography.
  • Management of visual impairment in preeclampsia is achieved by controlling the pathophysiologic mechanisms responsible for the condition – specifically, pharmacologic stabilization of abnormal vital signs and metabolic imbalances, magnesium sulfate administration for seizure prophylaxis, and labor induction or delivery as soon as feasible.
  • Treatment of blood pressure abnormalities in patients with cortical vision loss due to PRES from preeclampsia has been shown to result in the resolution of visual impairment and radiologic findings.
magnesium sulfate
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Renal
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benzodiazepines
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Adult
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Renal
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phenytoin
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  • Phenytoin, used as a second-line agent for seizure treatment and prophylaxis in preeclampsia and eclampsia, can cause cone and rod dysfunction and color vision deficits.
  • In addition to prompt delivery of the baby, treatment of patients with HELLP syndrome often requires acute blood transfusions and possible liver transplantation;
  • Retinal vascular changes and their progression are an indicator of fetal and maternal mortality.
  • Further, improperly managed preeclampsia and eclampsia can lead to permanent visual impairment.
  • Blood pressure measurements, both systolic and diastolic, and serum creatinine levels are staples of monitoring patients with preeclampsia and may be predictive of changes in dilated fundus examinations.
  • Long-term studies have also demonstrated an increased risk for retinal structural and vascular disease.
  • Preeclampsia is an independent risk factor for future stroke in patients later in life.
  • The development of preeclampsia during pregnancy can increase the risk for other eye and brain diseases post-partum.
  • Although vision often returns to baseline, retinal abnormalities and white matter lesions can develop during preeclampsia and persist, sometimes even many years after giving birth.
  • review
    Ocular Manifestations of Preeclampsia. StatPearls [Internet] — Ethan M. Stern, Nancy Blace — StatPearls Publishing, 2024

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov