Gravidez e disfunção lacrimal

Abstract

ResumoOBJETIVO: Verificar a prevalência de disfunção lacrimal em grávidas, comparando-a com a de mulheres não grávidas. Correlacionar achados de diminuição do filme lacrimal com antecedentes obstétricos. MÉTODOS: Foram entrevistadas 150 mulheres grávidas e 150 não grávidas para avaliação da presença de sintomas de secura ocular e antecedentes obstétricos. Os dois grupos foram submetidos ao teste de Schirmer I e a um questionário para sintomas de olho seco. Pacientes com colagenoses, uso de medicamentos associados à secura de mucosas, hepatite C e infecção por vírus da imunodeficiência humana, inflamação intraocular prévia ou cirurgia ocular foram excluídas. Os dados obtidos foram analisados por testes de χ 2 e Fisher quanto às variáveis nominais, e pelo t de Student e Mann-Whitney quando numéricos. A significância adotada foi de 5%. RESULTADOS: Os dois grupos não diferiram quanto aos sintomas relacionados à secura ocular. O valor absoluto do teste de Schirmer foi igual nos dois grupos, tanto para olho direito (p=0,3) como esquerdo (p=0,3). Todavia, as mulheres grávidas tiveram maior prevalência de disfunção lacrimal em pelo menos um olho (p=0,004). A ocorrência de disfunção lacrimal nos dois grupos (pacientes e controles) estava associada a maior número de gestações a termo por paciente (p=0,04), mas não com número de abortos (p=0,9), nem com o tempo da gravidez (p=0,5). CONCLUSÕES: Mulheres grávidas têm mais disfunção lacrimal do que não grávidas. Nos dois grupos a prevalência de disfunção lacrimal é mais alta em mulheres com maior paridade. Abstract PURPOSE:To assess the prevalence of lacrimal dysfunction during pregnancy comparing it to non-pregnant women and to correlate these findings with obstetric history. METHODS: We interviewed 150 pregnant and 150 non-pregnant women for symptoms of dry eyes and obstetric history. Both groups underwent Schirmer I testing and responded to a questionnaire on dry eye symptoms. Patients with collagen diseases, medications associated with dryness of mucous membranes, hepatitis C infection and AIDS, previous intraocular inflammation and eye surgery were excluded. Data were analyzed by the χ 2 and Fisher tests when the data were nominal and by the Student´s t-test and Mann-Whitney test when numerical. The level of significance was set at 5%. RESULTS: The two groups did not differ in symptoms of lacrimal dysfunction. The results of Schirmer's test were equal in both groups for the right eye (p=0.3) and left eye (p=0.3). However, pregnant women had a higher prevalence of at least one dry eye (p=0.004). The occurrence of dry eye in both groups (patients and controls) was associated with a greater number of full-term pregnancies/patient (p=0.04) but not with pregnancy time (p=0.5) or number of abortions (p=0.9). CONCLUSIONS: Pregnant women suffer more from lacrimal dysfunction than non pregnant women; in both groups the prevalence of tear dysfunction is more elevated in women with higher parity.

Subjective Dry Eye Symptoms in Pregnant Women–A SPEED Survey

“…During pregnancy, the body undergoes several physiological hormonal changes which could potentially cause dryness [ 8 ]. Previous research shows that disruption of acinar cells, lacrimal dysfunction, fluctuations in blood glucose levels, and altered tear film physiology and associated ocular surface changes are some of the contributing factors towards dry eye in pregnant women [ 8 – 10 , 28 , 29 ]. While the health care delivery and monitoring systems are well established during pregnancy, the eye care and vision related symptoms are often neglected.…”

“…Studies report that during pregnancy, lacrimal gland growth factor expression can be altered and lacrimal aci-nar cells could be damaged, increasing the risk of dry eye [8,9]. On the other hand, positive objective findings of dry eye among pregnant women with the absence of subjective findings are also reported [10][11][12][13][14]. Women undergo significant emotional and physiological changes during pregnancy [15,16].…”

A Narrative Review of the Complex Relationship between Pregnancy and Eye Changes

“…The dry eye syndrome secondary to the direct effects on the lacrimal acinar cells of prolactin, transforming growth factor beta 1 (TGF-β1), and epidermal growth factor is found at the level of the lacrimal apparatus [3,5]. Skare et al [8] identified an increased incidence of dry eye syndrome among pregnant women compared to the control group.…”

Ophthalmic Complications and Ocular Changes in Pregnancy- A Review

“…Tear production decreases due to lacrimal dysfunction, resulting in dry eye syndrome [5,6]. Also, corneal sensation is significantly decreased [7][8][9].…”