The generic term retinopathy describes a series of pathological, non-inflammatory and proliferating changes in the retina. Hypertensive retinopathy (retinopathy hypertensives) is understood to mean damage to the retinal vessels caused by chronic hypertension, which results in impairment of the retina. This may affect visual acuity and may even lead to blindness.
Causes of hypertensive retinopathy
Over the years, most hypertensive patients remain symptom-free, that is, they are subjectively well. Health problems are caused by the consequential damages of the constantly elevated blood pressure, which often only appear after a few years. This affects above all the vessels of the cardiovascular system.
Arterial calcification causes an increase in thickening of the inner walls of the vessel, which reduces the diameter of the vessel and thus reduces the blood flow in the vessels. As a result, there is an increasing increase in blood pressure in the vessels. In the heart, for example, this can lead to the development of coronary heart disease, including heart attacks. In addition, the vessels become brittle.
In addition, however, the small blood vessels in the entire organism, such as the so-called capillaries of the retina (retina), can be affected.
Effect of hypertension on the retina
The sensory cells in the retina (the light-sensitive rods and the color-recognizing cones) capture the different light stimuli that strike the eye from the outside world and pass them on to the brain, where they are finally processed into the image we perceive.
For undisturbed functioning of the retina, its supply of nutrients and oxygen via its blood vessels is very important. Chronic hypertension and the arteriosclerosis of the vessels resulting therefrom can lead to occlusion and / or increased permeability of these blood vessels supplying the retina.
As a result, disturbances in the nutrient and oxygen supply of the retina, which can lead to visual impairment to blindness.
Hypertonic retinopathy: symptoms and course
The constriction and / or perforation of the vessels causes line-shaped retinal hemorrhages and so-called cotton-wool foci (small, bright, cotton-like spots, which develop through occlusions of small retinal vessels), which causes a deterioration in vision.
If larger areas of blood vessels in the retina are closed by the disease, the retina tries to compensate for the resulting undersupply of oxygen by rebuilding vessels. However, these newly formed, intact vessels are extremely brittle and grow in part in the vitreous body in front of the retina, where they begin to bleed easily.
If such a hemorrhage is located in the place of the sharpest vision (macula), it can lead to an acute blindness of the patient. At the same time, the body's own attempt to remove the blood from the vitreous body leads to considerable scarring, which is accompanied by shrinkage of the retina and finally - due to the resulting tensile effect on the retina - can lead to tearing of the retina and thus also to blindness,
Early diagnosis is crucial
The hypertensive patients, the changes that destroy his eyesight, long time hidden. For retinal damage to be treated as early as possible, it is imperative that patients with high blood pressure regularly have their eyes checked.
By examining the fundus of the eye, the doctor can unambiguously detect pathological changes in the eye, diagnose a retinopathy and treat it accordingly before the patient even perceives the possible visual disturbances.
Eye reflection and dye examination
In the case of an ophthalmoscope, for example, cotton wool stoves, which are formed by the occlusion of small retinal vessels, can be identified by their characteristic stain-like appearance.
In the case of retinopathy, a colorectal examination (fluorescein angiography) can be used to determine whether a laser treatment of the retina is necessary. In this test, a dye is injected into the arm and then taken pictures of the eye or the supplying them vessels.
In this way, it can be determined whether and where fluid exits through the blood vessels of the retina. These can be closed by targeted irradiation with laser light, whereby a further escape of liquid from these porous vessels is prevented.
Complications of hypertensive retinopathy
If the retinopathy is not recognized right away and treated in time, the affected person is at risk of blindness.
The development of retinopathy is particularly unfavorable if the person at the same time suffering from diabetes mellitus, which may also be the trigger for retinopathy (diabetic retinopathy). In this case, another important therapeutic measure is the drug regulation of blood sugar.
Drug treatment of hypertensive retinopathy
The deterioration of vision due to a hypertensive retinopathy can often be at least partially reversed by a drug lowering blood pressure. However, only if hypertension is the sole cause of the pathological retinal change.
Laser therapy and icing
If the reduction in blood pressure does not lead to success, several alternative treatment methods are available: In the so-called laser therapy - also called laser coagulation or photo-coagulation - the pathological blood vessel proliferation on the damaged retina are deliberately "bombarded" with light rays and thus suppressing the formation of further vascular changes. Laser treatments are virtually painless and must be repeated depending on the stage of the disease.
When cryocoagulation (icing) areas of the retina are cooled to minus 70 degrees. This cold treatment corresponds in its effect to the laser treatment. It is used when laser treatment is no longer possible.
Surgery for hypertensive retinopathy
In advanced disease with extensive vascular proliferation and severe bleeding into the eye, the laser treatment is not enough. For the affected patients, a new surgical procedure is available today: vitreous surgery (vitrectomy).
In this microsurgical procedure, which is usually performed in a hospital setting and under local anesthesia, further bleeding can be avoided by removing the blood-filled vitreous and replacing it with a clear solution. If the retina has detached, this damage can also be corrected during vitreous surgery. Through this intervention, it is often possible to restore useful visual acuity.
Early detection of hypertensive retinopathy is the best protection against vision loss. The risk of vision loss due to a retion pathway can be reduced by regular ophthalmological examinations of the fundus.
Blood pressure should be checked regularly and if necessary adjusted by medication. In addition, care should be taken to avoid movements that lead to an increase in blood pressure in the head, such as the lifting of heavy objects or prolonged work in a stooping posture.
Furthermore, patients with chronic hypertension should abstain from nicotine and excessive alcohol consumption. Diabetics, who are particularly at risk of retinopathy, should also pay attention to an accurate adjustment of their blood sugar levels and strict compliance with their dietary requirements.