Pregnancy and Dry Eye Syndrome: A Review for Clinical Practice

TL;DR

Pregnancy can cause or worsen dry eye syndrome due to hormonal changes, but its role as a risk factor remains uncertain.

Contribution

This review provides a clinical summary of DES in pregnancy, focusing on mechanisms, diagnosis, and safe management.

Findings

DES affects 20-50% of pregnant women, especially in the second and third trimesters.

Estrogen and progesterone fluctuations are key factors in DES development during pregnancy.

Current evidence does not confirm pregnancy as a definitive risk factor for DES.

Abstract

Pregnancy is a unique physiological state associated with profound hormonal, metabolic, and immunological changes that may affect ocular surface homeostasis. Among these changes, fluctuations in estrogen and progesterone are the most consistent factors contributing to the development or exacerbation of dry eye syndrome (DES), although insulin resistance and maternal immune tolerance may also play a role in modulating disease severity. Current evidence suggests that DES can affect between 20% and 50% of pregnant women, most commonly during the second and third trimesters. Symptoms are often mild and self-limiting, but they can negatively impact quality of life and adherence to prenatal care. Importantly, however, current consensus reports such as TFOS DEWS III emphasize that pregnancy has not been established as a confirmed risk factor for DES and the evidence remains inconclusive despite the biological plausibility of hormonal influences. This review summarizes the pathophysiological mechanisms underlying DES in pregnancy, highlights diagnostic approaches and safe management strategies tailored for pregnant women, and emphasizes the importance of awareness among obstetricians and ophthalmologists. Greater recognition of DES in pregnancy may improve patient comfort and prevent long-term ocular complications.

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