Hypertensive retinopathy

Hypertensive retinopathy. Katrina Wittkamp

Hypertensive retinopathy is a complication of having chronic hypertension, or high blood pressure and affects the blood vessels in the retina. The retina is the clear, photosensitive tissue that lines the back of the eyeball. The retina processes and transforms light into nerve impulses that travel through the optic nerve to the brain where we interpret the impulses as vision. When our blood pressure remains high for too long, the blood vessels in our body and particularly in the eye may harden or become thickened.

When the vessels become too narrow from this thickening, the retina does not receive enough blood flow and become diseased because it does not receive enough oxygen and nourishment.

Symptoms of hypertensive retinopathy are sometimes very mild but some experience:

Optometrists and ophthalmologist can diagnose hypertensive retinopathy by completing an eye exam. Vision and eye health will be examined by the eye will also be dilated. Special drops instilled into the eye cause the pupil to become larger so that the internal structures of the eye. Eye doctors may use a biomicroscope and several different type of ophthalmoscope to view the internal structures. Sometimes additional testing such as optical coherence tomography (OCT) or fluorescein angiography may be needed to see more detail.

These tests will allow doctors to detect swelling in the retina and possible leakage of blood vessels. Changes that may indicate hypertensive retinopathy are:

  • Narrowing of the arteries:  The retinal arteries become very thin.

  • Arteriovenous crossing or nicking:  The arteries may cross over the veins abnormally and place undue pressure on them.

  • Copper wiring: The wall of the blood vessel changes and thickens and causes the vessel to look like a copper wire

More serious consequences of hypertensive retinopathy are:

  • Total vascular occlusion:  Sometimes due to arteriovenous nicking a branch retinal vein occlusion may occur. The vessel becomes occluded and may burst.

  • Superficial flame-shaped hemorrhages: These are hemorrhages that have a feathery or flame shape to them on the surface of the retina

  • Cotton-wool spots: These are white, superficial areas of the retina that lack oxygen.

  • Yellow hard exudates: This yellow fluid is intraretinal lipid deposition from leaking retinal vessels.

  • Optic disc swelling:  Optic disc swelling in hypertensive retinopathy is often referred to as a hypertensive crisis and treatment should be administered immediately.

Other medical problems that can occur to the eye from hypertension include:

  • anterior ischemic optic neuropathy

  • central retinal branch occlusion

  • brand retinal artery occlusion

  • cranial nerve palsies

  • worsening of diabetic retinopathy

  • neovascular glaucoma

  • macroaneurysms

  • ocular ischemic syndrome

Treatment of hypertensive retinopathy begins with controlling the hypertension.  If vision loss begins to occur, the retina is treated by injecting steroids into the eye. Also antivascular endothelial growth factor medications are injected also. Example of antivascular medications include ranibizumab, pegaptanib and bevacizumab. Retinal swelling is also sometime treated with a laser.

Significant damage can occur to other organs in the body as well. Hypertensive retinopathy can be prevented or minimized by taking blood pressure medications regularly, getting routine regular exercise, reducing salt intake and avoid smoking.

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