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Retinopathy

 
, medical expert
Last reviewed: 07.07.2025
 
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Retinopathy is a group of non-inflammatory diseases that lead to damage to the retina of the eye.

The main causes of retinopathy are vascular disorders that lead to circulatory disorders in the retinal vessels. Retinopathy manifests itself as a complication of arterial hypertension, diabetes mellitus, hematological diseases and other systemic diseases.

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Retinopathy in arterial hypertension

Arterial hypertension can lead to various changes in the fundus, the pathophysiology and severity of which depend on the stage of the disease.

Clinically, in arterial hypertension, two types of disorders in the fundus are distinguished:

  • vascular, represented by focal intraretinal, periarteriolar transudates, cotton-like foci, changes in retinal arterioles and veins, intraretinal microvascular disorders;
  • extravascular - retinal and macular edema, hemorrhages, hard exudate, loss of nerve fibers.

Retinopathy in arterial hypertension may be acute or in remission, depending on the nature of the underlying disease. Focal necrosis of the vessel walls causes hemorrhages in the nerve fiber layer, occlusion of superficial capillaries, formation of cotton-like spots that are localized in the nerve fiber layer, development of deep retinal edema and exudation in the outer plexiform layers. In the acute stage, arterioles narrow significantly, and edema of the optic disc may occur. Fluorescent angiography reveals circulatory disorders in the choroid that precede changes in the retina.

There are three qualitatively different stages in the course of arterial hypertension. According to these phases, one can often trace quite characteristic changes in the retinal vessels.

The first stage of arterial hypertension is the initial stage, when with already elevated blood pressure there are no noticeable symptoms and dysfunctions of the systems and organs. With arterial hypertension, the function of the terminal capillaries is primarily impaired (their permeability increases, resulting in numerous capillary hemorrhages and plasmorrhagia). If these hemorrhages occur in the retina, then with timely ophthalmoscopy technique, it is possible to see the smallest hemorrhages and plasmorrhagia in the form of white spots of various sizes with sharp boundaries and in different quantities. Thus, changes in the retina in the first stage of arterial hypertension may be absent or expressed in single small hemorrhages, mainly round in shape, located randomly. The thin venous branches around the macula, usually unnoticeable, become tortuous and easily noticeable (Gaist's symptom). With careful observation, periodic spastic narrowing of the arteries can be noticed. In the first stage, arterial hypertension is reversible, and with the appropriate regimen and treatment, hemorrhages disappear, and the function of the eye remains unchanged, since hemorrhages do not spread to the area of the central fossa.

The second stage of arterial hypertension is transitional. In this phase, deeper and irreversible changes occur in the terminal capillaries. Large vessels of the retina also change: the amount of hemorrhage in the retina increases; in addition to round hemorrhages, hemorrhages in the form of streaks along the retinal vessels are noted. Along with hemorrhages, large but isolated white spots of plasmorrhagia appear in the retina. In severe cases, the second phase of hypertension passes into the third.

The third stage of arterial hypertension is a stage that is usually irreversible. It is characterized by organic disorders of the entire vascular system and especially the terminal capillaries: in the brain, eye, parenchymatous organs. The retina has a typical picture: large white spots predominate, sometimes the entire retina is white. Hemorrhages recede into the background. A white star-shaped figure is often visible in the area of the central fossa. The optic disc is poorly contoured, its borders are sharply blurred. Atherosclerotic changes in the retinal vessels are strongly expressed: the artery walls thicken and lose their transparency. The blood flow at first seems yellowish, the artery looks like a copper wire, and then the blood flow in the artery does not shine through, the artery looks like a silver wire. The dense, sclerotic wall of the artery at the places of its intersection with the vein presses the vein into the thickness of the retina and disrupts the blood flow in it.

Due to the thickening of the wall and narrowing of the lumen, the tortuosity of the vessels and the unevenness of their caliber attract attention. Sometimes plasmorrhagia breaks through under the retina and causes its detachment. This picture indicates deep lesions of the terminal capillaries. In these cases, the prognosis is poor not only in relation to the function of vision, but also the life of the patient.

In diagnostics, in addition to ophthalmoscopy, which must be performed at least once a year, electroretinography is used to identify disturbances in the bioelectrical activity of the retina, the degree of change of which is used to judge the degree of retinal ischemia; perimetry, which can detect limited defects in the visual fields.

Treatment of retinopathy in arterial hypertension

Energetic treatment by therapists in a hospital setting in the first two stages of arterial hypertension gives quite satisfactory results.

Treatment should include antihypertensive therapy aimed at stabilizing blood pressure, which is carried out under the control of biochemical and rheological properties of the blood, as well as analysis of the coagulogram.

Prevention - active and widespread detection of arterial hypertension with mandatory ophthalmoscopy.

Hypertensive retinopathy

Diabetic retinopathy

Diabetic retinopathy is the main cause of blindness in diabetes mellitus. Ophthalmoscopy reveals isolated hemorrhages of varying size in the retina, often located in the fovea. Sometimes the ophthalmoscopic picture is similar to the picture observed in arterial hypertension. With successful treatment of diabetes mellitus, changes in the retina may disappear, and visual function is restored.

Diabetic retinopathy

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Retinopathy in diseases of the hematopoietic system

In myeloma leukopenia, fairly characteristic changes are found in the retina and its vessels. The entire retina is somewhat opalescent, and in some places in its layers, multiple yellowish-white rounded formations appear, which rise slightly above the level of the retina, surrounded by a ring of hemorrhage. The size of such foci is 1/5-1/3 of the diameter of the optic nerve disc. These elements are scattered mainly along the periphery, but they are often observed in the area of the central fossa, where their size reaches the diameter of the optic nerve disc.

As the hemoglobin level falls, the retinal vessels lose their tone, and the arteries become indistinguishable from the veins. The retina around the optic nerve thickens, and the edges of the disk become blurred. The background of the reflex is not red, but yellowish, anemic. The number of hemorrhages with white formations in severe myeloma leukopenia increases day by day, and the lesion in the macula lutea grows.

Rapid growth of myelomas occurs not only in the retina, but also in the dura mater - bones and other organs. Modern methods of treatment, which are used in hematology and oncology, have a positive effect and allow in some cases to prolong the life of the patient.

Changes in the retina in pernicious anemia A pale yellow coloration of the fundus reflex is observed due to a general decrease in the hemoglobin level (sometimes up to 10%), atony and dilation of blood vessels. As a result of the porosity of the walls of small vessels, hemorrhages appear in the retina, which are scattered throughout its length, sometimes preretinal hemorrhages in the area of the macula lutea (in the form of a circle with a line sharply cut off along the chord). Such hemorrhages are located in front of the retina and under the vitreous membrane. Despite significant measures, preretinal hemorrhages can be resorbed, in which case the visual function is restored.

Treatment of the disease and blood transfusions give quite good results.

Retinopathy in blood diseases

Sickle cell retinopathy

Radiation retinopathy

Radiation retinopathy may develop after treatment of intraocular tumors with brachytherapy or external beam radiation for malignant tumors in the sinuses, orbit, or nasopharynx.

The time interval from the start of irradiation to the onset of the disease is unpredictable and can vary on average from 6 months to 3 years.

Signs of radiation retinopathy (in order of manifestation)

  • Limited capillary occlusion with development of collaterals and microaneurysms; best seen on foveal angiography.
  • Macular edema, hard exudate deposits and retinal haemorrhages in the form of "flame" spots.
  • Papillopathy, widespread arteriolar occlusion and cotton wool lesions.
  • Proliferative retinopathy and tractional retinal detachment.

Treatment of radiation retinopathy

Laser photocoagulation, which is effective for macular edema and proliferative retinopathy. Papillopathy is treated with systemic steroids.

The prognosis depends on the severity. A poor prognostic sign is papillopathy and proliferative retinopathy, which can lead to hemorrhages and tractional retinal detachment.

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