The physiological adaptations of pregnancy encompass diverse systemic changes with significant ophthalmic relevance. These modifications may accelerate the progression of preexisting ocular diseases, including glaucoma and diabetic retinopathy, and can also initiate new entities, such as central serous chorioretinopathy and hypertensive retinopathy. While several ocular changes are physiological and self-limiting, such as decreased intraocular pressure, corneal thickening, and tear film instability, others may lead to significant visual morbidity or maternal–fetal complications. Vision threatening entities such as preeclampsia associated retinal detachment, Purtscher like retinopathy, and thrombotic microangiopathies necessitate prompt diagnosis and interdisciplinary management. Owing to the potential teratogenicity of many ophthalmic drugs, therapeutic strategies must be carefully selected, with preference given to noninvasive diagnostic modalities and safer pharmacologic alternatives. Greater awareness, coupled with close cooperation between ophthalmologists and obstetricians, is fundamental for safeguarding both visual and systemic health during pregnancy.