Preeclampsia is a multisystemic syndrome specific to pregnancy, a leading cause of maternal and neonatal morbidity and mortality with complex relations to various organs and systems of the body.

Ocular findings include retinopathy, optic neuropathy, retinal edema, subretinal fluid, retinal hemorrhages, Elschnig spots, cotton wool spots, segmental or generalized constriction of the retinal arterioles, and exudative retinal detachment.

Preeclampsia usually presents in the third trimester of the pregnancy. Visual symptoms are considered a manifestation of severe preeclampsia.

Pathological retinal characteristics and proximity of the lesions to the fovea predict visual symptoms.

Fundus photographs can show decreased retinal arterial-to-vein ratio.

Fluorescien angiography (FA) has been used to evaluate the vascular findings of preeclampsia in the retina, but due to the dye-based injection requirement, noninvasive imaging is often preferred during pregnancy.

Optical coherence tomography (OCT) provides a noninvasive means to image the retina in pregnant patients without risk to the fetus.

OCT findings are variable and may include foveal contour flattening, diffuse intraretinal edema that slowly resolves postpartum, subretinal fluid, serous retinal detachments, photoreceptor layer disruption, highly reflective retinal pigment epithelium (RPE) with thickened choriocapillaris, and V-shaped adhesions disrupting the outer retina reflecting Elschnig spots (Figures 20.1 and 20.2)