- Classification
- Types of hypertensive retinopathy and associated symptoms
- 1. Chronic hypertensive retinopathy
- 2. Malignant hypertensive retinopathy
- What is the diagnosis
- How the treatment is done
Hypertensive retinopathy is characterized by a group of changes in the fundus, such as retinal arteries, veins and nerves, which are caused by hypertension. The retina is a structure that is located at the back of the eyeball and has the function of transforming the light stimulus into a nervous stimulus, which allows vision.
Although these changes occur mainly in the retina, changes secondary to arterial hypertension can also manifest in the choroid and the optic nerve.
Classification
With regard to hypertensive retinopathy, only associated with hypertension, it is classified into degrees:
- Grade 0: no physical changes; Grade 1: moderate arteriolar narrowing occurs; Grade 2: arteriolar narrowing occurs with focal irregularities; Grade 3: occurs the same as in grade 2, but with retinal hemorrhages and / or exudates; Grade 4: occurs the same as in grade 3, but with swelling of the disc.
Types of hypertensive retinopathy and associated symptoms
Hypertensive retinopathy can be chronic, if associated with chronic hypertension, or malignant, if associated with malignant arterial hypertension:
1. Chronic hypertensive retinopathy
It is generally asymptomatic and appears in people with chronic hypertension, in which an arteriolar narrowing is manifested, alteration in the arteriolar reflex, an arteriovenous crossing sign, in which the artery passes anteriorly 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 rise in blood pressure, with systolic blood pressure values greater than 200 mmHg and diastolic blood pressure values above 140 mmHg, causing problems not only at the eye level, but also at the cardiac, renal and cerebral levels.
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, this type of retinopathy may cause changes in pigmentation in the eye, macular edema and neuroepithelial detachment from the macular region and ischemic papillary edema, with hemorrhages and spots.
What is the diagnosis
The diagnosis of hypertensive retinopathy is made by fundscopy, which is an examination in which the ophthalmologist is able to 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 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 the treatment is done
Chronic retinopathy rarely requires ophthalmic treatment. The need for ophthalmic treatment arises when complications occur in the retina.
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 hypertension crisis is overcome, the vision is usually recovered, totally or partially.
