What is hypertensive retinopathy and what are the symptoms

Content:

Hypertensive retinopathy is characterized by a group of changes in the fundus of the eye, such as retinal arteries, veins and nerves, which are caused by high blood pressure. The retina is a structure that is located at the back of the eyeball and its function is to transform the light stimulus into a nervous stimulus, which allows vision.

Although these alterations occur mainly in the retina, alterations secondary to arterial hypertension can also be manifested in the choroid and optic nerve.

Classification of retinopathy

With regard to hypertensive retinopathy, which is only associated with hypertension, it is classified into the following grades:

  • Grade 0 : no physical changes;
  • Grade 1 : moderate arteriolar narrowing occurs;
  • Grade 2 : marked arteriolar narrowing with focal irregularities;
  • Grade 3 : same as grade 2, but with retinal hemorrhages and/or exudates;
  • Grade 4 : Same as Grade 3, but with disc swelling.

Main types and symptoms

Hypertensive retinopathy can be chronic, if associated with chronic hypertension, or malignant, if associated with malignant hypertension:

1. Chronic hypertensive retinopathy

It is usually asymptomatic and appears in people with chronic hypertension, in which arteriolar narrowing is manifested, alteration in the arteriolar reflex, arteriovenous crossing sign, in which the artery passes anterior to the vein. Although rare, signs and symptoms such as retinal hemorrhages, microaneurysms and signs of vascular occlusion can sometimes appear.

2. Malignant hypertensive retinopathy

Malignant hypertensive retinopathy is associated with a sudden increase in blood pressure, with systolic pressure values ​​greater than 200 mmHg and diastolic pressure values ​​greater than 140 mmHg, causing problems not only at the eye level, but also in the heart, kidneys and brain.

Unlike chronic hypertensive retinopathy, which is usually asymptomatic, malignant hypertensive retinopathy is usually associated with headache, blurred vision, double vision, and the appearance of a dark spot in the eye. In addition, in this type of retinopathy, pigmentation changes in the eye, macular edema and detachment of the neuroepithelium of the macular region and ischemic papillary edema, with hemorrhages and spots, can occur.

How to confirm the diagnosis

The diagnosis of hypertensive retinopathy is made through funduscopy, which is an examination in which the ophthalmologist can observe the entire fundus of the eye and the structures of the retina, with the help of a device called an ophthalmoscope, and aims to detect changes in this region that may harm the eye. the vision. See more about this exam .

Fluorescein angiography can also be used, which is usually only necessary in atypical cases or to exclude the diagnosis of other diseases.

How is the treatment done?

Chronic retinopathy rarely requires ophthalmologic treatment. The need for ophthalmologic treatment arises when retinal complications occur.

On the contrary, malignant hypertensive retinopathy is a medical emergency. In these cases, blood pressure must be controlled in an effective and controlled manner, in order to prevent irreversible injuries. After the malignant hypertensive crisis is over, vision is usually fully or partially recovered.