Author of this page
Dr Serdal Sanak
Ophthalmic surgeon · Refractive and cataract surgery
CHIREC Hôpital Delta, Brussels
Member: ESCRS · SBO · SFO · SAFIR
Pregnancy and breastfeeding are periods during which refractive surgery is not performed. Three main reasons explain this temporary contraindication: hormonal changes that affect the cornea, refraction fluctuations observed during and after pregnancy, and the incompatibility of postoperative medications with pregnancy and breastfeeding.
This page details the timing to observe before a planned pregnancy, after childbirth, after a period of breastfeeding, as well as the precautions to take at the time of the preoperative exam.
The contraindication of refractive surgery during pregnancy and breastfeeding rests on three distinct elements: corneal instability induced by hormones, variation of refraction during this period, and the incompatibility of medications used at the preoperative exam and postoperatively. These three elements combine and make the procedure unsafe in terms of outcome and poorly compatible with the safety of the pregnancy.[3]
Oestrogens and progesterone modify the thickness and curvature of the cornea during pregnancy. The mechanism combines corneal water retention, tissue hyperlaxity and an alteration of the tear film. The cornea can thicken by several microns and its curvature can shift slightly.[1]
These variations are reversible after childbirth and cessation of breastfeeding, but they make preoperative measurements unreliable throughout this period. Corneal topography performed at the end of pregnancy does not reflect the stable geometry of the cornea. Pachymetry (measurement of corneal thickness) gives values altered by water retention. Yet these are the two measurements that determine the choice of technique and the calculation of the laser treatment.
Refraction (myopia, hyperopia, astigmatism) can vary by 0.5 to 1 dioptre during pregnancy and breastfeeding. A patient measured at -3 D early in pregnancy may be measured at -4 D at the end of pregnancy and return to -3.25 D six months after childbirth.[2]
Operating on a refraction that has not stabilised exposes the patient to a disappointing visual result, with a correction that is under-estimated or over-estimated compared to the real long-term need. Refractive surgery aims for stable vision over several decades and therefore requires a reliable measurement at the time of the procedure, which pregnancy and breastfeeding do not allow.
The preoperative exam and the procedure involve the use of several medications. At the exam, cyclopentolate (a cycloplegic) is instilled to dilate the pupils and temporarily block accommodation, which allows refraction to be measured without interference from the ciliary muscle. Postoperatively, antibiotic eye drops (fluoroquinolones such as ciprofloxacin or moxifloxacin), non-steroidal anti-inflammatory drops (NSAIDs such as diclofenac) and sometimes corticosteroids are prescribed for several weeks.
Cyclopentolate is classified category C by the FDA, to be avoided during pregnancy unless there is a clear medical indication. Systemic NSAIDs are contraindicated in the third trimester (risk of premature closure of the ductus arteriosus); topical NSAID drops have low systemic absorption, but the precautionary recommendation aligns with that of oral forms. Topical fluoroquinolones (ciprofloxacin, ofloxacin) have very low systemic absorption, considered compatible with breastfeeding according to the American Academy of Pediatrics; during pregnancy they remain to be avoided as a precaution despite the absence of documented increase in malformation risk. This accumulation of medication exposures, even at low doses, in a non-urgent context, is not clinically justified in a pregnant or breastfeeding patient.
Before surgery: no current pregnancy, refraction stable for 2 years.
Before conceiving after surgery: 3 to 6 months depending on the profile (6 months if the initial correction was strong).
After childbirth without breastfeeding: 3 months minimum.
After the end of breastfeeding: 6 months minimum.
Refraction stable for 2 years: standard criterion that always applies.
References
In a patient of childbearing age, the question of a current pregnancy or a plan for pregnancy in the near future is raised before the preoperative exam. It is recommended not to conceive within three to six months after the procedure, to allow vision to stabilise following a Femto-LASIK or a PRK.
The literature accepts a range of three to six months depending on the profile. The FDA does not impose a systematic delay, but most teams retain a minimum of three months for refraction to stabilise, with a preference for six months when the initial correction was strong. An earlier pregnancy remains possible from an obstetric standpoint but may be accompanied by a transient visual fluctuation, sometimes with a small refractive regression observed during pregnancy. This change is generally modest and regresses after childbirth.
In the case of childbirth followed by rapid weaning or an absence of breastfeeding, a delay of three months is retained to allow hormonal levels to return to their previous state and refraction to stabilise. The preoperative exam is then scheduled beyond this delay, based on a refraction confirmed by two measurements a few weeks apart.
Breastfeeding maintains a high level of prolactin, a hormone that continues to influence the cornea and the tear film. The delay retained is six months after the complete end of breastfeeding. An exam at this stage allows the stability of refraction and the absence of persistent corneal abnormality to be verified before scheduling the procedure.
A patient considering refractive surgery after two or three pregnancies must have had a stable refraction for at least two years, as for any candidate. Stability is assessed on the basis of previous comparative prescriptions (spectacles or contact lenses worn during this period), confirmed by a complete exam with refraction under cycloplegia.
If vision has changed by more than 0.5 dioptre over the last two years, an additional observation period is necessary before considering a procedure. This period allows verification that the change has indeed stopped and that the new correction is stable. In this case, two measurements six months apart giving the same result demonstrate stability.
In some patients, the myopia observed after a pregnancy does not return completely to its pre-pregnancy level. This change generally remains modest, of the order of 0.25 to 0.75 dioptre more than before the pregnancy, and without consequence for future eligibility for refractive surgery.
It simply requires that the new correction be stabilised over time before being operated on: two years of stability at the new value remain the rule. This phenomenon is more common in high myopes than in mild myopes, and is sometimes seen cumulatively over several successive pregnancies. The preoperative exam allows this change to be measured and guides the choice of technique appropriate to the new refractive value.
Can I have surgery if I am pregnant?
No. Refractive surgery is deferred throughout pregnancy for three reasons: hormonal fluctuations that make refraction unstable, cyclopentolate used at the preoperative exam classified category C (to be avoided during pregnancy), and postoperative medication exposure (antibiotics, NSAIDs) that is not clinically justified in a non-urgent context.
How long should I wait after childbirth before having surgery?
At least 3 months after childbirth if you are not breastfeeding, 6 months after complete cessation of breastfeeding. An exam at this stage confirms that refraction is stable before considering surgery.
Does breastfeeding contraindicate refractive surgery?
Yes. Breastfeeding hormones (prolactin) continue to affect the cornea. Some postoperative medications pass into breast milk. Waiting until complete cessation of breastfeeding plus 6 months is the rule.
Can pregnancy change my vision?
Yes, generally by 0.5 to 1 dioptre during pregnancy and breastfeeding. The cornea thickens slightly and its curvature changes under hormonal influence. Vision usually returns to its initial level 3 to 6 months after childbirth or cessation of breastfeeding.
What happens if I am pregnant without knowing it at the time of surgery?
The protocol includes a check beforehand: medical history and a pregnancy test if there is any doubt. If an early pregnancy is detected between the preoperative exam and the procedure, the procedure is postponed. If it is discovered after the procedure, appropriate obstetric follow-up is arranged; the postoperative eye drops are reassessed on a case-by-case basis with the gynaecologist.
Will my myopia increase again because of a future pregnancy?
Myopia can increase slightly during a pregnancy (0.25 to 0.75 D on average), and does not always return completely to its initial level. This change remains modest and does not compromise the result of a previous refractive surgery in the vast majority of cases.
The preoperative exam confirms the stability of your refraction and helps plan the timing of the procedure in view of your plans. Whether you are considering a pregnancy in the coming months or have recently given birth, a consultation allows the appropriate timing and the precautions to take to be defined.