REVIEW – November 2021

Visual complications of preeclampsia, eclampsia and HELLP syndrome

Authors: Andri Teesalu, Maris Oll

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Preeclampsia, eclampsia and HELLP syndrome (haemolysis, elevated liver enzymes and low platelet count syndrome) are pregnancyassociated hypertensive disorders, which can cause multiple organ dysfunction and can therefore also affect vision (2, 3). Decreased visual acuity, visual impairment, diplopia, amaurosis fugax, visual field scotomas and homonymous hemianopsia are the most common presenting symptoms caused by these complications (4). The major causes of the symptoms are central serous chorioretinopathy (CSC), cortical blindness and Purtscher-like retinopathy.
CSC’s main pathological mechanism is thought to be hyper-permeable capillaries together with retinal pigment epithelium dysfunction, which results in serous retinal detachment (6). The condition, which can occur both during as well as after pregnancy, is confirmed with optical coherence tomography (OCT) and usually resolves in a few months after pregnancy without any specific treatment (8).
Cortical blindness is a condition associated with posterior reversible leukoencephalopathy syndrome (PRES) (12). The pathological mechanism of cortical blindness is thought to be the loss of vascular autoregulation in the posterior part of the brain, resulting in oedema, which affects the visual pathways and visual cortex (4, 12). The condition results in progressive decrease of vision and can lead to total blindness (4, 13), sometimes beginning with prodromal symptoms of headache, nausea and vomiting (4, 12). The best methods for visualizing cortical oedema are computed
tomography and magnet resonance imaging (4, 6, 11, 12), no pathology is usually found in the eyes (16). Vision commonly recovers in 4 hours to 8 days without any specific treatment (11).
Purtscher-like retinopathy is a rare complication of pregnancy-associated hypertensive disorders, but unlike the others, can cause permanent vision loss (4). Clinical findings include Purtscher flecken, cotton-wool spots, retinal haemorrhage and optic nerve oedema (17). Treatment with corticosteroids has not been proven superior to no treatment (22).
The previously mentioned conditions are not vision-threatening, except for Purtscherlike retinopathy, and vision usually recovers fully after a few days. Nevertheless, it is still important to promptly diagnose these conditions, as they can be the first symptoms of underlying preeclampsia, eclampsia, or PRES, which require immediate medical assistance.