Hypertensive retinopathy: symptoms and treatment of the disease. Retinopathy

Retinopathy is a disease that causes damage to the retina. Related this pathology with different external reasons, among which diabetes, atherosclerosis, symptomatic hypertension or true hypertension. Retinopathy poses a danger to the patient’s vision, because against the background of the pathology, thrombosis of the retinal vessels develops with their occlusion. This leads to the defeat of the retina And optic nerve. if a patient with retinopathy is not provided with timely medical care, then optic nerve atrophy, retinal dystrophy and total loss visual function.

With hypertension, a special change occurs in the retina and the vessels in it, which is called hypertensive retinopathy. This disease most often complicates the course of hypertension and is manifested by the formation of hemorrhages, exudates in the retinal area, and swelling of the optic nerve.

At-risk groups

Among the patients who most often experience hypertensive retinopathy are:

• Elderly persons;
• People with hypertension;
• Patients with an adrenal tumor;
• Persons with renal hypertension.

The danger of retinopathy in hypertension is that its course is often asymptomatic, and therefore the patient does not know that in eyeball irreversible changes occur. Subsequently, there is a progressive decrease in visual acuity.

Stages of hypertensive retinopathy

During hypertension, four stages can be distinguished:

• Hypertensive angiopathy is manifested by functional, that is, reversible, changes in the vessels of the retina.
• In hypertensive angiosclerosis, transformations of the retinal vessels are already organic in nature.
• Hypertensive retinopathy is accompanied by the appearance of pathological foci in the retinal tissue, which are located around the changed vessels. This is characterized by clouding, hemorrhage and degenerative processes in the central zone. In some cases, the picture resembles a star or half-stars.
• In hypertensive neuroretinopathy, optic nerve fibers are involved in the pathological process. In addition to angipatia, retinopathy and angiosclerosis, swelling and opacification of the optic nerve head are observed. As pathological changes progress, a significant decrease in visual acuity and a narrowing of its fields occurs.

Diagnosis of hypertensive retinopathy

Patients with suspected hypertensive retinopathy should consult an ophthalmologist. In addition to the usual inspection, you should perform:

• Examination of the fundus using ophthalmoscopy.
• Ultrasound study of eye structures using A and B scanning modes.
• Optical coherence tomography the retina itself.
• Electrophysiological studies to clarify the state of the nerve conduction system.

Treatment of hypertensive retinopathy

Treatment of hypertensive retinopathy should begin with level correction blood pressure. Specific therapy depends on the stage of pathological changes. Most often on initial stages use anticoagulants, vasodilators, vitamin complexes. In addition, you can use surgical techniques (laser coagulation) or hyperbaric oxygen therapy.

The main goal of treatment for hypertensive retinopathy is to relieve distressing symptoms. Against this background, it is very important to stabilize blood pressure normal level, which requires continuous monitoring.

Under no circumstances should treatment be delayed, as this risks the patient becoming blind. It is important to remember that in case of complications, the damage to the retina will become irreversible. Therefore, it is necessary to regularly visit an ophthalmologist, especially for people at risk. This will help to make a timely diagnosis and, if necessary, carry out treatment.

Description:

Hypertensive reflects changes in the fundus during. Due to its high prevalence (23% of the unselected world population), it is expected that the incidence of fundus pathology associated with this disease will also increase.

Symptoms:

Keith-Wagner classification.

Stage I. Slight narrowing of arterioles or angiosclerosis. General state good, no hypertension.

Stage II. More pronounced narrowing of arterioles, arteriovenous crossings. No retinopathy. Hypertension. The general condition is good, the functions of the heart and kidneys are not impaired.

Stage III. Angiospastic retinopathy (wool-like foci, hemorrhages, retinal edema). High hypertension. Impaired heart and kidney function.

Stage IV. Papilloedema (swelling of the optic nerve) and significant vasoconstriction. The condition is threatening.
Clinic

There are 2 forms of fundus changes: fundus pathology without retinopathy and hypertensive retinopathy.

In the first form, the retinal arteries and arterioles have a more linear course, and numerous arteriovenous crossovers are observed. The wall of the artery is compacted, pressing on the underlying vein, causing a narrowing of the lumen of the vein at the intersection. In some cases, especially when combined with involutional sclerosis, the arterioles become sharply narrowed and pale—the “silver wire” symptom—and tortuosity and dilation of the veins appear—Gwist’s symptom. Developing hypertension is indicated by congestion in the vein distal to the arteriovenous chiasm. Sooner or later vascular changes the retina is complicated by retinopathy with the appearance of hemorrhages and exudate. Hemorrhages often occur in the macula and originate from the surrounding precapillary arterioles.

Some hemorrhages are located along the nerve fibers and have the appearance of stripes. Sheaths may form on the veins, which are deposits of white exudate.

At acute hypertension in individuals with high diastolic pressure, as a result of occlusion of the retinal arterioles, a true retinal infarction develops, looking like lumps of cotton wool (cotton exudate). Neovascularization of the retina and optic nerve may occur.

At malignant hypertension in the fundus, in addition to retinopathy, swelling of the optic nerve develops. In the macular area there may be deposits of hard exudate in the form of a star.

Causes:

Changes in the arterioles of the fundus of the eye during hypertension repeat the damage to the arterioles of other organs, in particular the brain. The main type of damage to the fundus is considered to be myeloelastofibrosis, less commonly hyalinosis, the severity of which depends on the duration of hypertension and the severity of hypertension.

The disease is caused pathological change directly in the human retina over a long period of time arterial hypertension. Hypertensive retinopathy is a serious disorder that requires treatment. If you do not start a therapeutic course on time, this may lead to a number of severe consequences, in particular, loss of vision.

Those most at risk include the elderly and hypertensive patients. The causes of the disease can be pathologies such as:

• Arterial hypertension;
• Diabetes;
• Kidney dysfunction;
• Pathologies of the adrenal glands;
• Improper treatment of hypertension;
• Atherosclerosis;
• Smoking abuse.

Note. By international classification The disease was assigned an ICD-10 code, since it develops against the background of hypertension. Labeling retinopathy H.35.0 - this is already defined as a disease related to retinal pathologies.

Symptoms of retinal damage

People with hypertensive retinopathy may not experience symptoms at the very first stage, but as the disease progresses, the following may occur:

• Floating black spots before the eyes;
• Loss of visual acuity (images become blurrier);
• Difficulty focusing the gaze (defocusing);
• Dark stripes are often observed in the field of vision;
• For more late stages possible headaches.

In addition, the patient may occasionally experience sudden appearance flashes of light before the eyes or, conversely, darkened large spots. In this case, as a rule, there is discomfort in the form of heaviness in the eyeball area.

Establishing diagnosis

An accurate diagnosis is made based on certain examinations, which include:

• Fundus examination;
• Retinal tomography;
• Electrophysiological examination;
• Ultrasound of both eyes.

A thorough examination of both eyes is carried out using special device- ophthalmoscope. Diagnostics on such a device can only be performed by experienced specialist. Most often, after this procedure, the doctor can almost accurately refute retinopathy or diagnose it.

Types and classification

Experts distinguish between two types of disease - primary and secondary retinopathy. Due to the fact that this disease is a consequence of arterial hypertension, and not an independent disease, it is classified as secondary type. Pathology also has several classifications:

Primary

1. Pigmented- in the vast majority of cases it occurs against the background of a genetic predisposition. The first symptom of pigmentary retinopathy is night blindness. It manifests itself at a young age, and the chances of curing this pathology are extremely low. If the disease is acquired, then the situation looks a little different. A cure in this case is possible, but only with intensive care at an early stage.
2. Central serous- a consequence of toxic-infectious pathologies, as well as frequent severe stress. Manifests itself most often in the form sharp deterioration vision and retinal edema. This retinopathy is caused by fluid getting under the retina of the eye. The highest risk group includes men from 20 to 50 years old. The disease can be aggravated by stress, nervous overstrain, as well as due to taking certain corticosteroid drugs. Without timely and correct treatment, retinal detachment is possible.
3. External exudative- most often develops in one eye in people young, predominantly in men. It appears mainly due to diabetes mellitus, but there are other causes.

Note. The most dangerous species- external exudative. If left untreated this type retinopathy, then glaucoma and other dangerous diseases may develop in the near future.

Secondary

• Hypertensive;
• Consequence of blood diseases;
• Atherosclerotic;
• Hypotonic;
• Diabetic;
• Traumatic.

Retinopathy of premature babies also occurs. It occurs due to insufficient development of the retina and its unpreparedness for proper functioning.

Stages of hypertensive retinopathy

There are only four stages of development of retinopathy, which have almost the same symptoms, but different consequences:

Treatment principle

The basic principles of treatment are based on eliminating the pathology, preventing its progression and returning visual acuity. The latter is not always possible, since diagnosis at the initial stage is difficult due to the lack of symptoms. Moreover, during the development of the disease, damage to the retina occurs every day more and more, which often leads to irreversible consequences. Most often, to treat the disease, the ophthalmologist prescribes:

• Drugs with a vasodilating effect;
• Vitamin complexes to restore vision;
• Drugs that prevent the formation of blood clots;
• Laser coagulation of the retina.

If the disease is at the first stage and therapy is started in a timely manner, the prognosis is favorable. In case of protracted illness V advanced stage It is impossible to predict the outcome, since everything depends on the correctness of the prescription and on how severely the retina is damaged.

In addition, much depends directly on the age of the patient. Diseases in young people are almost always cured faster than in older people.

Retinal changes. The primary reaction of retinal arterioles in response to systemic hypertension is a narrowing (vasoconstriction). However, the degree of narrowing depends on the volume of replacement fibrous tissue(involutional sclerosis). For this reason, hypertensive constriction in pure form 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 blood-retinal barrier are disrupted with increased vascular permeability. The fundus picture of hypertensive retinopathy is characterized by the following symptoms.

The narrowing of the arteries can be local or generalized. Ophthalmoscopic diagnosis of generalized narrowing is difficult, while the presence of local narrowing indicates high probability high blood pressure. Severe hypertension may be accompanied by obstruction of precapillary arterioles and the development of cotton wool lesions.

Sweating of blood vessels leads to the appearance of hemorrhages in the form of “tongues of flame” and swelling of the retina. At chronic edema In the retina, a hard exudate with a “star shape” is deposited around the fovea in the Henle layer. Papilledema is a manifestation of malignant hypertension.

Arteriolosclerosis is represented by thinning of the vascular wall, histologically characterized by intimal hyalinization, media hypertrophy and endothelial hyperplasia. The most important clinical symptom are changes in the area of ​​arteriovenous junctions (arteriovenous compression). However, this symptom does not always reflect the severity of hypertension, as it may pre-exist for many years. Minor changes in the area of ​​arteriovenous junctions are observed in patients with involutional sclerosis in the absence of arterial hypertension.

With a prolonged increase in blood pressure, the structure of the vascular wall is disrupted due to constant overstrain. If the retinal arteries are affected, this complication is called hypertensive retinopathy. The disease is most severe when renal hypertension, as well as in pregnant women with severe toxicosis. Progressive retinal angiopathy can result in complete and irreversible loss of vision.

Read in this article

Causes of development of hypertensive retinopathy

Depending on the current arterial hypertension There may be such options for damage to the retina:

• causes short-term intense vasospasm and swelling in the area of ​​the optic nerve.
• constantly high pressure leads to increased permeability of arteries, thickening of their walls, damage inner shell and necrotic changes.

Factors that contribute to retinopathy: diabetes mellitus, toxicosis of pregnancy, nephrotic syndrome, smoking.

Detection of changes in the vessels of the retina is a sign of similar disorders in the entire arterial network.

Symptoms of changes in the retina of the eye

For a long period of time, signs of retinopathy are not felt by patients. The first manifestations may be floating spots or dots when looking into the distance.

When the optic nerve is swollen, a veil appears before the eyes, the contours of objects lose their clear outlines, and difficulties arise when doing work that requires visual strain. In the evening and at night, as well as in conditions poor lighting

The vision loss becomes more severe.

• With severe retinopathy, retinal detachment may occur. Its symptoms are:
• black stripes or shapeless spots in the field of vision,
• floating stripes,
• flashes or sparks,
• shadow or veil before the eyes,

blurry images.

People at risk

• The occurrence of retinopathy is most likely in patients with poorly controlled hypertension, as well as concomitant factors that aggravate its course.
• These include:
• hereditary predisposition,
• elderly age,
• elevated blood sugar and cholesterol levels,
• menopause,
• obesity,
• work in hazardous working conditions (noise, vibration, chemical compounds, high or low temperature),
• stress,
• unhealthy diet, namely excess salt, animal fats and sugar in food,
• low physical activity,
• diseases of the endocrine system,

smoking,

chronic alcoholism.

Watch the video about hypertensive retinopathy: Stages of disease progression Initial changes in blood vessels include reversible disturbances in their tone; local or general narrowing of the lumen and compression of nearby veins may be noted. When blood pressure levels normalize, signs hypertensive angiopathy disappear. Similar clinical picture

can be found even in

healthy people

• after 40 years of age during fundus examination.
• retinal swelling;
• “tongues of flame” from hemorrhages in the retina.

At the fourth stage, all the initial signs are accompanied by swelling of the optic disc, the visual picture of which is called the macular “star,” and partial retinal detachment. The phase of hypertensive neuroretinopathy is characterized by a pronounced and irreversible decrease in visual acuity.

Diagnostic methods

To determine the presence of changes in the fundus and their correspondence to the stage of retinopathy, the following studies are carried out:

In order to distinguish hypertensive retinopathy from diabetic, autoimmune, and radiation retinopathy, blood tests for sugar and an immunological profile are prescribed.

Treatment of hypertensive retinopathy

The success of therapy depends on the stage of hypertension and compensation of high blood pressure with the help.

If you apply in a timely manner medical assistance(on the first or initial signs stage 2), in most patients the normal structure of the arterial wall is restored within 1 to 3 months.

Complete restoration of vision in later stages, as a rule, cannot be achieved. Such patients may be prescribed coagulation (cauterization) of blood vessels using a laser. It makes it possible for areas with poor oxygen supply to receive additional nutrition.

IN complex treatment The following groups of drugs are used:

• vasodilators,
• vitamins,
• anticoagulants,
• growth factor inhibitors to inhibit excessive vascular proliferation,
• corticosteroids.

Some products are used for... Good results obtained from a course of hyperbaric oxygen therapy.

Hypertensive retinopathy is a change in the structure vascular walls retina of the eye.

Its manifestations reflect systemic arterial lesions in uncompensated arterial hypertension. With the development of sclerotic compactions, obstruction of blood flow and involvement of the optic nerve in the process, the outcome of the disease can be complete loss of vision. Initial stages

respond well to treatment provided blood pressure levels are normalized.

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