Index
It is a disease characterized by retinal degeneration due to high blood pressure.
The retina is the layer of tissue at the back of your eye. This layer transforms light into nerve signals that are then sent to the brain for interpretation.
When your blood pressure is too high, the walls of the blood vessels in your retina can thicken. This can cause your blood vessels to narrow, which then prevents blood from reaching the retina. In some cases, the retina swells.
Over time, high blood pressure can damage the blood vessels in the retina, limit the function of the retina, and put pressure on the optic nerve, causing vision problems. This condition is called hypertensive retinopathy.
Symptoms
You probably won’t have any symptoms until the condition has progressed extensively. Possible signs and symptoms include:
- Reduced vision
- Swelling of the eyes
- Explosion of a blood vessel.
- Double vision accompanied by headaches.
Get medical help right away if your blood pressure is high and your vision changes suddenly.
Causes
Prolonged high blood pressure or hypertension is the main cause of heart failure .
High blood pressure is a chronic problem in which the force of the blood against the arteries is too high. Force is the result of blood pumping from the heart into the arteries and the force created when the heart rests between heartbeats.
When blood moves through the body at higher pressure, the tissue that makes up the arteries will begin to stretch and eventually become damaged. This leads to many problems over time.
Hypertensive retinopathy usually occurs after your blood pressure has been consistently high for a long period of time. Your blood pressure levels can be affected by:
- A lack of physical activity.
- Being overweight.
- Eating too much salt.
- A stressful lifestyle.
- High blood pressure also runs in families.
In the United States, high blood pressure is quite common. According to the Centers for Disease Control and Prevention, the condition affects 1 in 3 adults in the United States. It is called a “silent killer” because it usually has no symptoms.
Risk factor’s
The following conditions put you at increased risk for hypertensive retinopathy:
- Prolonged high blood pressure.
- Heart disease.
- Atherosclerosis .
- Diabetes.
- Smoke
- High cholesterol.
- Being overweight.
- Eat an unhealthy diet.
- Excessive alcohol consumption.
Additionally, the condition is more common in people of African descent, particularly Afro-Caribbean people. Women are also more likely to be affected by blood vessel damage than men.
Diagnosis
Ophthalmoscope: A doctor will use a tool called an ophthalmoscope to examine your retina. This tool shines a light through your pupil to examine the back of your eye for signs of narrowing of the blood vessels or to see if there is any fluid leaking from the blood vessels. This procedure is painless. It takes less than 10 minutes to complete.
Fluorescein angiography: In some cases, a special test called fluorescein angiography is done to examine the blood flow in the retina. In this procedure, your doctor will apply special eye drops to dilate your pupils and then take pictures of your eye. After the first round of imaging, your doctor will inject a dye called fluorescein into a vein.
Classification of hypertensive retinopathy
The extent and severity of retinopathy is generally represented on a scale of 1 to 4. The scale is called the Keith-Wagener-Barker classification system. All four grades increase in severity:
- In grade 1 there is a mild narrowing of the retinal artery.
- Grade 2 is similar to grade 1, but there are more severe or stricter constrictions of the retinal artery. This is called an arteriovenous, or AV, pinch.
- Grade 3 has the signs of grade 2, but there is also retinal edema, microaneurysms, cotton spots.
- Grade 4 has severe grade 3 signs along with optic disc swelling called papilledema and macular edema.
People with grade 4 retinopathy are at increased risk for stroke and may have kidney or heart disease.
At the lower end of the scale, you may not have any symptoms. However, in grade 4, your optic nerve can start to swell and cause more serious vision problems. High-grade retinopathy tends to indicate serious blood pressure problems.
Complications
People with hypertensive retinopathy are at risk of developing retinal-related complications. These include the following:
Ischemic optic neuropathy – Occurs when high blood pressure blocks normal blood flow in the eyes and damages the optic nerve. The optic nerve carries images of what we see to the brain.
Retinal artery occlusion: Occurs when the arteries that carry blood to the retina are blocked by blood clots. When this happens, the retina does not get enough oxygen or blood. This results in loss of vision.
Retinal vein occlusion: Occurs when the veins that carry blood away from the retina are blocked by blood clots.
Cotton spots: they are white spongy lesions on the retina. Nerve fiber layer ischemia or damage to nerve fibers can cause them.
Malignant hypertension: This is a rare condition that causes blood pressure to rise suddenly, interferes with vision, and causes sudden vision loss. This is a life threatening condition.
People with hypertensive retinopathy are also at higher risk of having a stroke or heart attack .
Treatment
Effective treatment for hypertensive retinopathy involves controlling and lowering high blood pressure with a combination of medications and lifestyle changes.
Changes in lifestyle
A diet rich in fruits and vegetables can help lower blood pressure. Regular physical activity, reducing your salt intake, and limiting the amount of caffeine and alcoholic beverages you drink also contribute to healthy blood pressure.
If you smoke, take steps to quit. If you are overweight, losing weight is an effective strategy to control high blood pressure.
Medicines
Your doctor may prescribe blood pressure medications such as diuretics, beta blockers, or ACE inhibitors.
You can control this condition by controlling your blood pressure. However, if your condition is severe, you may have irreversible eye damage that causes permanent vision problems.
Prediction
The prognosis is worse for the higher grades of human resources. Grades 3 and 4 are associated with higher rates of:
- Heart attack.
- Congestive heart failure
- Death.
People with grade 4, uncontrolled hypertension, sometimes called the “malignant stage,” have a generally poor prognosis for survival.
Structural changes in the arteries of the retina are generally not reversible. Even with treatment, patients diagnosed with HR are at increased risk of retinal artery and vein occlusions and other retinal problems.
If you have high blood pressure or HR, it is important that your primary care physician works with your eye doctor (ophthalmologist) to determine an appropriate treatment plan. They can work together to monitor your condition.
Prevention
Tips to prevent hypertensive retinopathy:
- Take your blood pressure medicine regularly.
- Get regular exercise.
- Eat a balanced diet.
- Avoid smoking.
- Get regular checkups to make sure your blood pressure readings are normal.
