Hypertensive retinopathy

Diagnosis of systemic hypertension is based on data from several blood pressure measurements with indices ranging from 140/90 mm Hg. Art. And higher.

[1], [2], [3], [4], [5]

Symptoms of hypertensive retinopathy

Changes in the retina. The primary reaction of retinal arterioles in response to systemic hypertension is narrowing (vasoconstriction). However, the degree of narrowing depends on the replacement volume of fibrous tissue (involutional sclerosis). For this reason, hypertension narrowing in pure form is observed only in young people. In elderly patients, the degree of constriction is less because of the rigidity of the arterial wall due to involutional sclerosis. With prolonged hypertension, a small area of the internal hematoretinal barrier is disturbed with an increase in vascular permeability. The picture of the fundus in hypertensive retinopathy is characterized by the following symptoms.

The narrowing of the arteries can be localized or generalized. Ophthalmoscopic diagnosis of generalized narrowing is complicated, whereas the presence of local narrowing indicates a high probability of high blood pressure. Severe hypertension may be accompanied by obstruction of precapillary arterioles and the development of vata-like foci.

Sweating of the vessels leads to the appearance of hemorrhages in the form of "tongues of flame" and edema of the retina. With chronic edema of the retina, a solid exudate is deposited with the "star shape" around the fovea in the Henle layer. Edema of the optic disc is a manifestation of malignant hypertension.

Arteriolosclerosis is represented by the thinning of the vascular wall, histologically characterized by the hyalinization of the intima, hypertrophy by media and hyperplasia of the endothelium. The most important clinical symptom is the changes in the arteriovenous crossovers (arteriovenous compression). However, this symptom does not always reflect the severity of hypertension, since it can exist before it for many years. Minor changes in the arteriovenous crossovers are observed in patients with involutional sclerosis in the absence of arterial hypertension.

Diagnostic criteria for hypertensive retinopathy

[6], [7], [8], [9], [10]

Choroidal changes

Changes in the choroid are rare, but can occur as a result of acute hypertensive crises in young (accelerated hypertension).

• Elschnig spots are small, dark, surrounded by yellow halos (halo), representing areas of local choroid infarction.
• The Siegrist bands are flaky particles along the choroidal vessels, which are indicators of fibrinoid necrosis associated with malignant hypertension.
• Exudative retinal detachment - sometimes bilateral, may occur with acute and severe hypertension, associated, for example, with pregnancy toxemia.

[11], [12]

Classification of arteriosclerosis

• Degree 1. Minor enlargement of arteriolar light reflex, moderate generalized thinning of arterioles, especially small branches, and "disappearance" of veins.
• Degree 2. Obvious expansion of the arteriolar light reflex and change in the course of veins in the arteriovenous crosshairs (Salus marker).
• Degree 3. The sign of the "copper wire" of the arterioles, the fullness of the veins distal to the arteriovenous crosshair (Bonnet sign), the narrowing of the veins before and after the LV crosshair (Gunn sign) and the venipuncture at right angles.
• Degree 4. A symptom of "silver wire" and a change of the third degree.

[13], [14], [15]

Concomitant diseases of the eye and complications of hypertension

• Occlusion of retinal veins.
• Occlusion of retinal arterioles.
• Macroaneurysms of the retinal arteries.
• Anterior ischemic optic neuropathy.
• Paralysis of the oculomotor nerve.

Uncontrolled hypertension can promote the development of diabetic retinopathy.

[16], [17], [18], [19], [20], [21], [22], [23], [24], [25]