Hypertensive retinopathy

The diagnosis of systemic hypertension is made on the basis of several blood pressure measurements with readings of 140/90 mm Hg and higher.

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Symptoms of hypertensive retinopathy

Retinal changes. The primary reaction of retinal arterioles to systemic hypertension is narrowing (vasoconstriction). However, the degree of narrowing depends on the volume of replacement by fibrous tissue (involutional sclerosis). For this reason, hypertensive narrowing in its pure form is observed only in young people. In elderly patients, the degree of narrowing is less due to the rigidity of the arterial wall caused by involutional sclerosis. With prolonged hypertension, small areas of the internal hematoretinal barrier are disrupted with increased vascular permeability. The fundus picture in hypertensive retinopathy is characterized by the following symptoms.

Arterial stenosis may be local or generalized. Ophthalmoscopic diagnosis of generalized stenosis is difficult, while the presence of local stenosis indicates a high probability of elevated blood pressure. Severe hypertension may be accompanied by obstruction of precapillary arterioles and the development of cotton-wool foci.

Vascular leakage leads to the appearance of "flame-shaped" hemorrhages and retinal edema. In chronic retinal edema, a hard exudate with a "star-shaped" shape is deposited around the fovea in the Henle layer. Edema of the optic disc is a manifestation of malignant hypertension.

Arteriolosclerosis is represented by thinning of the vascular wall, histologically characterized by hyalinization of the intima, hypertrophy of the media and hyperplasia of the endothelium. The most important clinical symptom is changes in the area of arteriovenous crossings (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 area of arteriovenous crossings are observed in patients with involutional sclerosis in the absence of arterial hypertension.

Diagnostic criteria for hypertensive retinopathy

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Choroidal changes

Choroidal changes are rare, but may occur as a result of acute hypertensive crises in young people (accelerated hypertension).

• Elschnig spots are small, dark, surrounded by yellow halos, representing areas of local choroidal infarction.
• Siegrist bands are flocculent particles along the choroidal vessels and are indicators of fibrinoid necrosis associated with malignant hypertension.
• Exudative retinal detachment - sometimes bilateral, may appear with acute and severe hyperthermia associated, for example, with toxicosis of pregnancy.

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Classification of arteriolosclerosis

• Grade 1. Slight widening of the arteriolar light reflex, moderate generalized thinning of the arterioles, especially small branches, and “disappearance” of the veins.
• Grade 2. Obvious widening of the arteriolar light reflex and change in the course of the veins in the area of arteriovenous crossings (Salus sign).
• Grade 3. Copper wire sign of arterioles, plethora of veins distal to the arteriovenous crossing (Bonnet's sign), narrowing of veins before and after the PV crossing (Gunn's sign) and branching of veins at right angles.
• Grade 4. Silver wire symptom and grade 3 changes.

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Concomitant eye diseases and complications in arterial hypertension

• Retinal vein occlusion.
• Occlusion of retinal arterioles.
• Macroaneurysms of the retinal arteries.
• Anterior ischemic optic neuropathy.
• Oculomotor nerve paralysis.

Uncontrolled hypertension may contribute to the development of diabetic retinopathy.

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