HYPERTENSIVE RETINOPATHY

Changes of the retina in the arterial hypertension are the indicator of the state of blood vessels in other organs; therefore, examination of the eye background should be an integral part of treatment and monitoring of hypertensive patients.

Hypertensive retinal vascular disease is graded in four levels.

 
I degree

This degree reflects the initial stage of hypertensive changes in blood vessels. Arteries are narrower, brighter reflex so they are reminiscent of the silver or copper wire. They are often of unequal lumens – in places they are narrowed or expanded.

II degree

At this stage you can see changes in the arteries as in the first stage (narrow arteries of unequal caliber), and changes in the course of veins: in places where they intersect with arteries the lumen is narrowed (Gunn sign), the crossing angle is changed (Salus sign) as a result of arterial pressure on the vein. Sometimes you see hard exudates and small retinal hemorrhages. These changes are a result of irreversible morphological changes in the membranes of the vessels and are a sign of generalized vascular disease.

III degree

With the changes of the second stage, what can also be seen are the signs of retinal disease – edema, hemorrhage and soft exudates in the retina. Soft exudates are the result of an ischemia in the optic nerve fiber layer, which causes a delay in axonal transport. They are a sign of malignancy or rapid worsening of hypertension, and also of decompensated generalized vascular disease. Average life expectancy after diagnosis of changes of the third degree is about two and a half years.

IV degree

This degree is made out of third-degree changes with the optical disk edema. The fourth degree of retinal changes in hypertension is a sign of serious changes in the nervous system, heart and kidneys. In the extended duration of the fourth degree of hypertensive retinopathy often develop star-like hard exudates in the macula. Such patients have a poor prognosis – an average life expectancy after diagnosis of changes of degree IV is about 11 months.