Eye Drugs in Pregnancy and Breastfeeding: Quick Reference
Last updated: October 2026
How to choose eye medicines for pregnant and breastfeeding patients. Systemic absorption from drops is small but real, and is reduced by punctal occlusion or gentle eyelid closure for 2 minutes after each drop. Use the lowest effective dose and involve the obstetrician for anything systemic.
| Group | Pregnancy | Breastfeeding |
|---|---|---|
| Glaucoma: beta-blockers (timolol) | Usable at the lowest dose; can cause fetal bradycardia, so tell the obstetrician, especially near delivery | Concentrated in milk; watch the baby for slow heart rate and breathing problems |
| Glaucoma: alpha-agonist (brimonidine) | Often preferred in pregnancy, but stop before delivery (risk of neonatal apnoea and CNS depression) | Avoid: can cause apnoea and drowsiness in infants |
| Glaucoma: topical CAIs (dorzolamide, brinzolamide) | Limited data; usually acceptable as second line | Generally acceptable |
| Glaucoma: prostaglandin analogues | Usually avoided (theoretical uterine effects); use only if others fail | Probably acceptable |
| Oral acetazolamide | Avoid, especially in the first trimester | Considered compatible in short courses |
| Non-drug glaucoma options | SLT is a good choice to reduce drops; IOP often falls during pregnancy | — |
| Antibiotic drops (fluoroquinolones, tobramycin, erythromycin, moxifloxacin) | Topical use acceptable | Acceptable |
| Systemic antibiotics | Avoid tetracyclines (doxycycline); azithromycin and amoxicillin are commonly used | Avoid doxycycline courses beyond a few days |
| Antivirals (acyclovir, valacyclovir) | Considered safe when indicated | Compatible |
| Topical steroids | Acceptable at the needed dose | Acceptable |
| Topical NSAIDs | Avoid regular use in the third trimester | Acceptable |
| Antihistamine / mast-cell drops (olopatadine, ketotifen, cromoglicate) | Acceptable; cromoglicate has the longest record | Acceptable |
| Dilating drops (tropicamide, phenylephrine 2.5%, cyclopentolate) | Single diagnostic use is acceptable with punctal occlusion; avoid phenylephrine 10% | Acceptable |
| Topical anaesthetic, fluorescein strip, povidone-iodine 5% | Acceptable for examination and procedures | Acceptable |
| Fluorescein angiography (IV) | Avoid unless it will change management, especially in the first trimester; OCT angiography is an alternative | Excreted in milk; some advise pausing for 24–48 hours |
| ICG angiography | Does not cross the placenta in meaningful amounts; use only if essential | Probably acceptable |
| Intravitreal anti-VEGF | Avoid if possible (VEGF is needed for placental development); if essential, ranibizumab is often preferred for its shorter systemic half-life; consider laser or steroid alternatives | Ranibizumab preferred if essential; bevacizumab and aflibercept are detectable in milk |
| Isotretinoin, systemic retinoids | Contraindicated (teratogenic) | Avoid |
Common situations: diabetic retinopathy can worsen in pregnancy, so examine each trimester; central serous chorioretinopathy is more common in pregnancy and usually resolves after delivery; IOP often falls in the second and third trimesters, so some patients can reduce drops under monitoring.
The old FDA letter categories (A, B, C, D, X) were replaced in 2015 by narrative labelling; decisions should balance the risk of untreated eye disease against limited safety data. Check a current reference (for example LactMed for breastfeeding) for specific drugs.
Related: glaucoma medications chart, steroids and infection regimens, ocular pharmacology.
Key sources
- Razeghinejad MR, Tai TY, Fudemberg SJ, Katz LJ. Pregnancy and glaucoma. Surv Ophthalmol 2011;56:324–35
- Samples JR, Meyer SM. Use of ophthalmic medications in pregnant and nursing women. Am J Ophthalmol 1988;106:616–23
- Polizzi S, Mahajan VB. Intravitreal anti-VEGF injections in pregnancy: case series and review of literature. J Ocul Pharmacol Ther 2015;31:605–10
- NIH LactMed database (drugs and lactation)
📘 Want more exam-ready material? See Most Commons in Ophthalmology on Kindle, or browse all my books.
Looking for an eye specialist in Ahmedabad? Learn about our Eye Department or book a consultation with Dr. Dhaval Patel.