Keratoconus and Pregnancy: How Hormones Affect Your Vision

Is there a connection between keratoconus and pregnancy? Does it affect the baby? Can pregnancy itself cause keratoconus? We hear these questions often — usually from women already diagnosed with keratoconus who naturally worry about how the changes of pregnancy might affect their eyes. The answers below are evidence-based and careful, and they should reassure you if you're planning to start a family while living with keratoconus.

Is There a Link Between Keratoconus and Pregnancy?

Pregnancy is one of the most demanding seasons of a woman's life. Nausea, joint pain, hemorrhoids — the changes that come with bringing a child into the world touch almost every part of the body, and the eyes are no exception. Where keratoconus and pregnancy meet, the cornea responds to hormonal shifts much as it does in other corneal conditions. If keratoconus is silent or undiagnosed, pregnancy may unmask it. If you already carry the diagnosis, the changes can be more noticeable. None of this is cause for alarm — below you'll find what to expect, what causes it, and how to manage it well.

Keratoconus and Pregnancy: The Changes That Can Occur

Keratoconus is not the only eye condition influenced by pregnancy. To put it in context, here are the broader pregnancy-related visual changes that can affect mother and baby.

The first is eclampsia, or pregnancy-related seizures. Its precursor, pre-eclampsia — marked by high blood pressure and proteinuria from around the 20th week of pregnancy — can cause visual symptoms including temporary vision loss, light sensitivity, flashes, and blurred vision.

The second is central serous chorioretinopathy. Some pregnant women experience severe forms of this disease, which can cause blurred vision, a central blind spot, distortion of straight lines, and difficulty reading.

The third is retinal vascular occlusion. A small number of women develop retinal vessel disturbances in the immediate postpartum period, with vision loss in both eyes; some experience arterial or venous retinal occlusions.

When it comes specifically to keratoconus, patients fall into two groups.

The first group is women with subclinical or undiagnosed keratoconus — the disease is already present but has not been diagnosed or has not produced symptoms. Most of the time there is little or only very mild change, and when the disease does become visible, it is typically in the later months of pregnancy.

The second group is women already diagnosed with keratoconus, particularly at more advanced stages. Here, progression can become noticeable in the later months. There is no need to panic — appropriate monitoring and treatment are available, and we will walk through them.

So what drives these corneal changes during pregnancy?

• Fluid retention: pregnancy-related fluid changes affect the cornea, making it more pliable and sensitive, sometimes thickening and steepening it. These shifts mostly occur in late pregnancy and can cause temporary changes in refraction.
• Increased oestrogen: oestrogen levels rise dramatically during pregnancy, and that rise influences the cornea directly — most notably in the seventh and eighth months. Why does oestrogen affect the cornea?

Because oestrogen softens connective tissue to facilitate childbirth — and the cornea is softened along with it. In a patient with pre-existing keratoconus, this can amplify progression.

Who Is at Risk for Keratoconus Changes During Pregnancy?

• If you do not have keratoconus, pregnancy is unlikely to affect your cornea in this way.
• If you have subclinical or undiagnosed keratoconus, symptoms may emerge — particularly in the later months.
• If you already carry the diagnosis, expect a higher likelihood of measurable progression in the later months.

How to Manage Keratoconus During Pregnancy

This article may sound full of warnings, and we understand that can be unsettling. Our goal is to be honest and supportive — to give you the tools and knowledge to navigate this season safely and welcome your baby in good health. Here is how to manage keratoconus while pregnant:

1. If you do not have keratoconus but a family member does, see your ophthalmologist for a baseline corneal map. It makes tracking any changes during pregnancy easy.

2. If you already have keratoconus and wear rigid contact lenses, see your doctor at least every 3 months to monitor corneal shape. You may need a new pair of lenses if the current ones stop centring on the cornea.

*Note: contact lenses that touch or rub the centre of the cornea can quickly cause corneal scarring or perforation — a fast track to corneal transplantation.

3. If your keratoconus is stable and you don't wear contact lenses, an eye check during pregnancy is still a good idea to confirm there is no progression.

4. If you have allergies such as hay fever, ask your obstetrician which allergy medications are safe in pregnancy — particularly those that affect the eyes.

5. Have your thyroid hormone levels checked.

Note: thyroid dysfunction has also been associated with keratoconus progression during pregnancy.

Now that you know what to do during pregnancy, let's answer the most common question:

Does pregnancy cause keratoconus?

No. Pregnancy does not cause keratoconus — particularly if a woman did not previously have it. It can, however, produce mild visual changes in some patients.

Why Patients Choose Dr. Ahmed Shaarawy for Keratoconus Care in Pregnancy

Dr. Ahmed Shaarawy is a lecturer and consultant in corneal and refractive surgery at the Research Institute of Ophthalmology. He completed his PhD and a corneal fellowship at the Devers Eye Institute in Oregon, USA, training under leading American corneal surgeons. He was the first surgeon in Egypt to perform posterior lamellar corneal transplantation using the s-stamp technique, has helped train many surgeons in this approach, and has presented his work at conferences across the United States and the Arab world. His record of successful outcomes and his use of the most current techniques have made him a trusted name in Egyptian ophthalmology.

Finally — don't let pregnancy-related changes worry you unduly. Bringing a healthy child into the world is a profound gift, and a few temporary changes are well worth the journey. Stay in close contact with your ophthalmologist so any change can be addressed promptly.