Navigating Glaucoma: What Glaucoma Medications Are Safe During Pregnancy?

October 11, 2025 •

4 min read

While intraocular pressure (IOP) may decrease naturally during pregnancy, approximately 10% of pregnant patients with glaucoma still experience elevated pressure or disease progression, necessitating treatment. Knowing what glaucoma medications are safe during pregnancy is crucial for managing the condition effectively while minimizing risk to the fetus.

Quick Summary

This guide examines the safety of different glaucoma medication classes, like alpha-agonists, beta-blockers, and prostaglandins, during various stages of pregnancy. It discusses managing the condition with the lowest possible dose and explores non-medical treatments.

Key Points

Pre-conception Planning: Discussing glaucoma management with a doctor before becoming pregnant is ideal for establishing a baseline and creating a risk-averse treatment plan.
Trimester-Specific Choices: Glaucoma medication safety varies by trimester; some drugs, like brimonidine, are favored early but contraindicated near delivery.
Minimize Systemic Absorption: Use techniques like nasolacrimal occlusion (punctual pressure) and eyelid closure to reduce the amount of medication absorbed systemically.
Consider Laser Therapy: For suitable candidates, selective laser trabeculoplasty (SLT) is a safe and effective non-medical alternative to control IOP throughout pregnancy.
Collaborative Care: Management requires close coordination between an ophthalmologist, obstetrician, and neonatologist to ensure the safety of both the mother and baby.
Avoid Certain Medications: Systemic carbonic anhydrase inhibitors and brimonidine late in pregnancy should be avoided due to significant fetal and neonatal risks.
Continued Monitoring Postpartum: Be mindful of risks during breastfeeding; some medications pass into breast milk and can affect the infant, necessitating further discussion and potential treatment changes.

The Challenge of Treating Glaucoma in Pregnancy

Managing glaucoma in a pregnant patient involves a critical balancing act: controlling the mother's intraocular pressure (IOP) to prevent vision loss while minimizing any potential risk to the developing fetus. This task is complicated by the limited human safety data available for most topical eye drops and the fact that all medications can cross the placenta to some degree. Many drugs are classified based on animal studies, not human trials, highlighting the need for careful consideration and collaboration between an ophthalmologist and obstetrician.

Medications and Safety by Trimester

Glaucoma medications are typically prescribed based on FDA pregnancy categories and risk assessments. Recommendations can change depending on the stage of pregnancy due to different risks during fetal development. Minimizing systemic absorption through techniques like nasolacrimal occlusion is key throughout treatment.

First Trimester (Weeks 0–12)

This period is crucial for fetal organ development, making it the highest-risk time for potential medication-induced malformations.

Observation: For patients with mild or stable glaucoma, careful observation without medication may be the safest option.
First-line: Brimonidine (an alpha-2 agonist) is often recommended as a first-line agent because it is classified as FDA Category B (presumed safe based on animal studies). However, it must be discontinued near term due to the risk of central nervous system depression and apnea in newborns.
Other options: Some clinicians may consider topical beta-blockers, but they are typically reserved for more severe cases.

Second Trimester (Weeks 13–27)

With organogenesis largely complete, the risk of malformation decreases, allowing for more treatment flexibility.

Continued Brimonidine: Brimonidine remains a viable first-line option during this period.
Beta-blockers: Topical beta-blockers, like timolol, can be considered as a second-line treatment, though they are FDA Category C. Careful monitoring of fetal heart rate and growth is recommended.
Topical CAIs: Topical carbonic anhydrase inhibitors (CAIs), such as dorzolamide, are also second-line choices.

Third Trimester (Weeks 28–40)

As the delivery date approaches, risks shift to neonatal complications.

Discontinue Brimonidine: Brimonidine is contraindicated late in the third trimester due to the risk of neonatal CNS depression.
Preferred options: Beta-blockers and topical CAIs are generally the preferred medications during this stage, with continued monitoring of the infant's heart rate and growth.
Avoid Prostaglandins: Prostaglandin analogs (PGAs), such as latanoprost, are typically avoided or used with caution in late pregnancy due to the theoretical risk of inducing uterine contractions.

Non-Pharmacological Treatments for Glaucoma in Pregnancy

For some patients, especially those planning a pregnancy or with poorly controlled IOP, non-medical interventions offer a safer alternative to long-term medication use.

Selective Laser Trabeculoplasty (SLT): SLT is a safe and effective option for lowering IOP and can reduce or eliminate the need for medication during pregnancy. It can be performed in any trimester.
Laser Peripheral Iridotomy (LPI): For patients with angle-closure glaucoma, LPI is a safe and effective treatment.
Glaucoma Surgery: Surgery is typically avoided during the first trimester due to anesthesia risks and the use of anti-metabolite agents. If necessary, it is usually performed in the second or third trimester using local anesthesia.

Techniques to Minimize Systemic Absorption of Eye Drops

To reduce fetal exposure, patients should be educated on proper eye drop instillation techniques:

Nasolacrimal Occlusion (Punctal Occlusion): Immediately after instilling the drop, apply gentle pressure with a finger to the inner corner of the eye for at least one minute.
Eyelid Closure: Close the eye for one to two minutes after instillation.
Blotting Excess: Blot any excess liquid from the eyelid to prevent further systemic absorption.
Lowest Effective Dose: Use the lowest concentration and frequency required to control IOP.

Conclusion: A Personalized, Multi-Disciplinary Approach

Managing glaucoma during pregnancy is a complex process that demands a personalized, multi-disciplinary approach involving the patient's ophthalmologist, obstetrician, and neonatologist. No single medication is risk-free for all situations, and the safest approach depends on the severity of the glaucoma, the stage of pregnancy, and a careful risk-benefit analysis. In many cases, effective treatment can be maintained throughout pregnancy while ensuring the health of both mother and child. For patients with mild or stable disease, observation may be a suitable initial strategy, while those with more aggressive glaucoma may need trimester-specific adjustments to their medication regimen, potentially supplemented or replaced by laser therapy. It is also crucial to discuss plans for breastfeeding, as medication risks can also apply postpartum. The best course of action is determined through ongoing communication and monitoring throughout the pregnancy and postpartum period.


Medication Class	FDA Category	First Trimester	Second Trimester	Third Trimester	Lactation	Key Considerations
Brimonidine	B	First-line	First-line	Avoid (stop by 37 weeks)	Avoid	Risk of neonatal CNS depression
Beta-blockers (e.g., Timolol)	C	First or second line	Second-line	Use with caution, monitor fetus	First-line (except heart disease)	Monitor fetal heart rate; risk of bradycardia
Topical CAIs (e.g., Dorzolamide)	C	Third-line	Second-line	Use with caution, monitor neonate	First-line	Monitor for neonatal acidosis
Prostaglandin Analogs (e.g., Latanoprost)	C	Third-line	Third-line	Second-line (avoid near term)	First-line	Theoretical risk of uterine contractions
Systemic CAIs	C	Avoid	Acute need only	Acute need only	As needed	High teratogenic risk in first trimester

For more information and clinical guidance on managing glaucoma during pregnancy, the EyeWiki page on the topic can provide further details.(https://eyewiki.org/Glaucoma_Management_in_Pregnancy_and_Postpartum)

Frequently Asked Questions

Topical timolol, a beta-blocker, is classified as FDA Category C but is often considered a suitable option for pregnant women. It is important to use the lowest effective dose with nasolacrimal occlusion and to monitor the fetus for potential cardiac side effects, especially if used close to delivery.

Brimonidine is often used as a first-line treatment during the first and second trimesters because it is a Category B drug. However, it must be discontinued by 37 weeks of pregnancy, as it can cross into the fetal circulation and cause CNS depression in newborns.

Prostaglandin analogs (PGAs) are FDA Category C and typically avoided during early pregnancy due to the theoretical risk of inducing uterine contractions, although the topical dose is very low. They can be considered in the second and third trimesters, but cautious use is advised, especially near term.

For mild or stable glaucoma, the safest approach is often observation, particularly during the high-risk first trimester. If treatment is necessary, a first-line medication like brimonidine or consideration of laser therapy can be discussed with your doctor.

Topical carbonic anhydrase inhibitors (CAIs) are Category C and generally used cautiously, particularly avoiding them during the first trimester due to potential teratogenic effects seen in animal studies. Oral CAIs should be avoided unless acutely necessary.

Nasolacrimal occlusion is a technique where you apply gentle pressure to the inner corner of your eye after instilling a drop. This closes off the drainage duct, significantly reducing the amount of medication that is absorbed systemically and minimizing fetal exposure.

Yes, laser treatments are considered a safe and effective option for managing glaucoma during pregnancy. Selective laser trabeculoplasty (SLT) is often recommended as it can reduce or eliminate the need for medication.