What are the four hypertensive retinopathy grades?
- In Grade 1, there’s a mild narrowing of the retinal artery.
- Grade 2 is similar to grade 1, but there’s more severe or tighter constrictions of the retinal artery. ...
- Grade 3 has the signs of grade 2, but there’s also retinal edema, microaneurysms, cotton-wool spots (fluffy white lesions on the retina), and retinal hemorrhages (bleeding).
What is the prognosis for retinopathy?
The visual prognosis strongly depends on the stage of the diabetic retinopathy and, above all, whether it is accompanied by diabetic macular oedema. When the condition is diagnosed early, it can be stabilised with the aid of modern treatments and usually does not affect the patient’s vision.
What does hypertensive retinopathy mean?
What does hypertensive-retinopathy mean? A retinal condition occurring in accelerated hypertension and characterized by arteriolar constriction, flame-shaped hem...
Can hypertensive retinopathy be reversed?
Treatment of Hypertensive RetinopathyThere is no cure for these conditions, any vision loss that occurs cannot be reversed. Subsequently, question is, is hypertensive retinopathy permanent? Outcome.
What is commonly seen in hypertensive retinopathy?
Common hypertensive retinal changes are flame-shaped hemorrhages in the superficial layers of the retina and cotton-wool patches caused by occlusion of the precapillary arterioles with ischemic infarction of the inner retina.
What are the two most common findings with hypertensive retinopathy?
Hypertensive retinopathy stagesGrade 1: High blood pressure and narrowing of the arteries is mild. ... Grade 2: High blood pressure and narrowing of the arteries is more pronounced.More items...•
How is hypertensive retinopathy diagnosed?
Your 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 blood vessels or to see if any fluid is leaking from your blood vessels. This procedure is painless. It takes less than 10 minutes to complete.
What is hypertensive retinopathy?
Hypertensive retinopathy is an eye condition that can occur in people with high blood pressure. The increased blood pressure damages the delicate blood vessels of the eye and retina and can lead to vision loss.
How can you differentiate between diabetic retinopathy and hypertensive retinopathy?
Diabetic retinopathy is caused by high blood sugar. Hypertensive retinopathy is caused by high blood pressure. Both conditions are diagnosed by an eye doctor. Treatment options may include surgery, laser treatments, or eye injections.
Is exudates seen in hypertensive retinopathy?
Signs of hypertensive retinopathy include superficial, flame-shaped hemorrhages, arteriovenous crossing changes (nicking), retinal arteriole narrowing/straightening, copper- or silver-wire arteriole changes (arteriolosclerosis), cotton-wool spots, microaneurysms, hard exudates (may be in a circinate or macular star ...
What are cotton wool spots?
Cotton-wool spots (CWSs) are common retinal manifestations of many diseases including diabetes mellitus, systemic hypertension, and acquired immunodeficiency syndrome. Clinically they appear as whitish, fluffy patches on the retina and eventually fade with time.
What is the pathophysiology of hypertensive retinopathy?
Pathophysiology of Hypertensive Retinopathy Early findings include generalized narrowing of the retinal arteriolar vessels due to vasospasm and increased vascular tone. Chronic hypertension leads to structural changes in the vessel wall such as intimal thickening and hyaline degeneration.
What are the fundus changes in a hypertensive?
Hypertensive retinopathy causes vascular constriction of retinal arterioles and typical fundus findings, such as blot hemorrhages, hard exudates and cotton wool spots resulting from ischemia within the nerve fiber layer.
What causes cotton wool spots?
Cotton-wool spots are tiny white areas on the retina, the layer of light-sensing cells lining the back of the eye. Caused by a lack of blood flow to the small retinal blood vessels, they usually disappear without treatment and do not threaten vision. They can, however, be an indication of a serious medical condition.
How does hypertension affect the eyes?
High blood pressure can damage blood vessels in the retina. The retina is the layer of tissue at the back part of the eye. It changes light and images that enter the eye into nerve signals that are sent to the brain. Damage to the retina from high blood pressure is called hypertensive retinopathy.
What are the fundus changes in a hypertensive?
Hypertensive retinopathy causes vascular constriction of retinal arterioles and typical fundus findings, such as blot hemorrhages, hard exudates and cotton wool spots resulting from ischemia within the nerve fiber layer.
What is the pathophysiology of hypertensive retinopathy?
Pathophysiology of Hypertensive Retinopathy Early findings include generalized narrowing of the retinal arteriolar vessels due to vasospasm and increased vascular tone. Chronic hypertension leads to structural changes in the vessel wall such as intimal thickening and hyaline degeneration.
What are cotton wool spots?
Cotton-wool spots (CWSs) are common retinal manifestations of many diseases including diabetes mellitus, systemic hypertension, and acquired immunodeficiency syndrome. Clinically they appear as whitish, fluffy patches on the retina and eventually fade with time.
What is the most common cause of malignant hypertension?
What causes malignant hypertension? Uncontrolled high blood pressure is one of the main causes of malignant hypertension. Other causes include: Adrenal disorders including Conn's syndrome, Cushing's syndrome, pheochromocytoma or a renin-secreting tumor.
What are the factors that contribute to hypertensive retinopathy?
Apart from essential and secondary hypertension, there are other factors which play an important role in the development of hypertensive retinopathy. The prevalence of hypertensive retinopathy is more in Afro-Caribbean as compared to Europeans and more in women as compared to men. Genetic factors can also play a role with certain genotypes associated with an increased risk of hypertensive retinopathy.[4] Pontremoli et al. studied the genetic factors linked to hypertensive retinopathy and found the deletion of the allele of the angiotensin-converting enzyme has a higher risk associated with the development of hypertensive retinopathy.[5] Smoking is considered to have a strong association with severe or malignant hypertensive retinopathy as studied by Poulter et al.[6]Renal dysfunction (persistent microalbuminuria and low creatinine clearance) in patients has shown to be a marker for hypertensive retinopathy and end-organ damage.[7] Uckaya et al. found an association with plasma leptin. It was observed that plasma leptin levels were higher in patients with hypertensive retinopathy and postulated that it is associated with vascular endothelium damage. [8]
What is the treatment for mild hypertensive retinopathy?
Mild hypertensive retinopathy:The treatment consists of controlling of BP with regular monitoring.
What is the purpose of a retinal screening?
The main purpose of screening for hypertensive retinopathy is that retinal vessels are the only blood vessels visible on routine examination. The effects of chronically elevated HTN are easily visible in the eye as hypertensive retinopathy and choroidopathy, and this reflects the vascular changes occurring in other systems. Ophthalmologists and general physicians should work in collaborations to ensure that hypertensive patients are efficiently screened, and timely managed to reduce the risk of ocular and systemic morbidity and mortality.[12] Henderson et al., however, noted that Hypertensive retinopathy is associated with an increased risk of stroke even after controlling BP and other vascular risk factors. [2]
What is the damage to the retina?
Poorly controlled hypertension (HTN) affects several systems such as the cardiovascular, renal, cerebrovascular, and retina. The damage to these systems is known as target-organ damage (TOD).[1] HTN affects the eye causing 3 types of ocular damage: choroidopathy, retinopathy, and optic neuropathy.[2] Hypertensive retinopathy (HR) occurs when the retinal vessels get damaged due to elevated blood pressure. There has been significant evidence that hypertensive retinopathy acts as a predictor of systemic morbidity and mortality due to TOD.[1] A study by Erden et al. showed that the increase in the incidence of retinopathy is related to the degree of severity and duration of HTN.[3]
Is HTN a risk factor for diabetes?
Diabetic retinopathy (DR): Both hypertensive retinopathy and DR together in a patient is called as mixed retinopathy. HTN is also known to be a major risk factor for the progression of DR.
Can hypertensive retinopathy cause visual loss?
Chronic hypertensive retinopathy rarely causes significant visual loss. The retinal changes can be halted when hypertension is treated. However, arteriolar narrowing and AV changes persist. For untreated malignant hypertension, the mortality is high as 50% within 2 months of diagnosis and almost 90% by the end of 1 year.[13] Vision loss in hypertensive retinopathy is because of either secondary optic atrophy after prolonged papilloedema or retinal pigmentary changes after exudative retinal detachment.
Is hypertensive retinopathy asymptomatic?
Hypertensive retinopathy is usually asymptomatic and is diagnosed on fundoscopic features. The following are signs of hypertensive retinopathy.
What is hypertensive retinopathy?
Updated on May 24, 2020. Hypertensive retinopathy is a complication of having chronic hypertension, or high blood pressure and affects the blood vessels in the retina. 1 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 ...
What changes indicate hypertensive retinopathy?
Changes that may indicate hypertensive retinopathy are: 2 . 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 ...
Why does my retina become diseased?
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. ...
What is the term for burst blood vessels on the outside of the eye?
Bursting blood vessels on the outside of the eye (subconjunctival hemorrhages)
What is the swelling of the optic disc?
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: Treatment of hypertensive retinopathy begins with controlling hypertension.
What Is Hypertensive Retinopathy?
High blood pressure is a chronic problem that damages blood vessels all over your body and can lead to heart failure. Heart attacks, strokes, heart failure, and kidney damage are all well-known problems associated with high blood pressure, especially uncontrolled blood pressure problems. Few people associate vision loss with high blood pressure, but hypertensive retinopathy is very common.
How does hypertension affect the retina?
Symptoms & Progression of Hypertensive Retinopathy. Hypertension causes the walls of blood vessels to thicken, which decreases how much blood can flow through them. In the eyes, reduced blood supply to the retina can cause the tissues to starve and die, leading to vision loss. Symptoms include:
How many degrees of retinopathy are there?
Ophthalmologists have graded retinopathy into four degrees, according to the level of damage to your retina:
Why does hypertension cause vision loss?
This causes vision loss. Doctors call this malignant hypertension because it can be difficult to manage, and systemic damage can be so serious. The amount of blood vessel damage around the retina tends to correlate with blood vessel hardening and damage in other parts of the body.
What is grade 2 vision?
Grade 2: Blood vessels have changed and hardened, and you have experienced a little vision loss like dim vision. Some clinicians refer to this phase as the sclerotic phase.
Why do my eyes get damaged?
All parts of your body contain numerous tiny blood vessels so tissues can get enough oxygen, and your eyes contain thousands of these blood vessels. Without proper blood flow, the delicate tissues in your eyes become damaged. You may develop optic nerve damage, fluid buildup under the retina, or blood vessel damage around the retina.
What is the grade of a retinal swell?
This is called the exudative phase by clinicians. Grade 4: Swelling occurs in the macula, which is the center of the retina, as well as in the optic nerve due to blood leaking from damaged blood vessels. This causes vision loss.
How to manage hypertensive retinopathy?
Hypertensive retinopathy is managed primarily by controlling hypertension. Other vision-threatening conditions should also be aggressively controlled. If vision loss occurs, treatment of the retinal edema with laser or with intravitreal injection of corticosteroids or antivascular endothelial growth factor drugs (eg, ranibizumab, pegaptanib, bevacizumab) may be useful.
What is the treatment for retinal edema?
Treat primarily by controlling blood pressure, and, for retinal edema, sometimes laser or intravitreal injection of corticosteroids or antivascular endothelial growth factor drugs.
What is the predisposing factor for vascular occlusion?
Sometimes total vascular occlusion occurs. Arteriovenous nicking is a major predisposing factor to the development of a branch retinal vein occlusion.
What is the cardinal funduscopic feature of malignant hypertension?
The cardinal funduscopic feature of malignant hypertension is optic disk swelling, which appears as blurring and elevation of disk margins. The image also shows a characteristic star-shaped macular lesion caused by leaking retinal vessels.
Does hypertension affect the retina?
Chronic hypertension progressively damages the retina, causing few or no symptoms until changes are advanced.
Is hypertension a risk factor for diabetic retinopathy?
Hypertension is a major risk factor for other retinal disorders (eg, retinal artery or vein occlusion , diabetic retinopathy ). Also, hypertension combined with diabetes greatly increases risk of vision loss. Patients with hypertensive retinopathy are at high risk of hypertensive damage to other end organs.
How to treat hypertensive retinopathy?
Treating hypertensive retinopathy typically involves controlling high blood pressure through lifestyle changes, medication and careful monitoring. Through this, the condition can be halted, and the damage may slowly heal.
What are the complications of hypertensive retinopathy?
Individuals with hypertensive retinopathy are at risk of various complications, including: [2] Retinal vein occlusion occurs when a vein in the retina becomes blocked due to clots.
What is the condition where the blood vessels in the back of the eye become damaged?
Hypertensive retinopathy occurs when the blood vessels supplying blood to the retina in the back of the eye become damaged. The likelihood of damage to the retina increases with the severity of high blood pressure and the length of time over which the condition is experienced. Older people are most at risk of developing high blood pressure ...
What is the condition where the eye is damaged?
Hypertensive retinopathy is an eyesight disorder that occurs as a result of high blood pressure. High blood pressure, also called hypertension, occurs when the force of blood against the artery walls is too high, causing the arteries to stretch, narrow and become damaged over time.
What is the term for the damage to the retina?
Hypertensive retinopathy (HR) is a possible complication of high blood pressure (hypertension). Persistent, untreated high blood pressure can cause damage to the retina, the tissues at the back of the eye responsible for receiving the images we need to see.
What is the best way to see the retina?
In some cases, an ophthalmoscope may be used to investigate the retina in the back of the eye. This instrument shines light into the eye, allowing doctors to see any signs of damage. More rarely, a test known as a fluorescein angiography may be performed to investigate the blood flow into the retina.
What does it mean when you have high blood pressure?
Headaches. Loss of vision, when the condition has progressed significantly. If these symptoms come on very quickly, this can be a sign of severely high blood pressure and should be considered a medical emergency. Call a doctor immediately.
What is the etiology of hypertensive retinopathy?
Etiology. The arteriosclerotic changes of hypertensive retinopathy are caused by chronically elevated blood pressure, defined as SBP greater than 140 mmHg and DBP greater than 90 mmHg. Primary hypertension is usually essential and not secondary to another disease process.
What is the risk factor for arteriosclerotic hypertensive retinopathy?
The major risk for arteriosclerotic hypertensive retinopathy is the duration of elevated blood pressure. The major risk factor for malignant hypertension is the degree of blood pressure elevation over normal. Some studies suggest a genetic influence on retinal vascular caliber.
What medications are used to treat hypertension?
Drugs that are commonly used in the outpatient setting to reduce blood pressure include angiotensin converting enzyme inhibitors, calcium channel blockers , and diuretics . Other less commonly used medications include α-adrenergic blockers, direct vasodilators, and central α 2 -adrenergic agonists. The patient should be followed by his primary physician closely for management of hypertension. If the patient is in hypertensive crisis, he should be referred to an emergency department for acute management of blood pressure.
What should be asked about hypertension?
The history should focus upon the hypertension disease history, symptoms of hypertension, and history of its complications. To gauge hypertension disease severity, patients should be asked about their severity and duration of hypertension, and about the medications taken as well as compliance. Symptoms of hypertension to ask about include headaches, eye pain, reduced visual acuity, focal neurological deficits, chest pain, shortness of breath, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and palpitations. Patients should be asked about the complications of hypertension, including history of stroke or transient ischemic attack, history of coronary or peripheral vascular disease, and history of heart failure. Many patients may be asymptomatic.
What causes papilledema in the optic nerve?
Malignant hypertension can cause papilledema (Figure 3), which is a result of both leakage and ischemia of arterioles supplying the optic disc that undergo fibrinous necrosis. Ischemia causes optic nerve edema, while leakage causes hemorrhage and disc edema.
How many people have hypertension?
In the United States, 33% of adults have hypertension and only 52% have controlled blood pressures. Hypertensive retinopathy ranges from 2-17% in non-diabetic patients but the prevalence varies by demographic groups. Hypertensive retinopathy is more common in African Americans and Chinese descent.
What are the effects of systemic arterial hypertension?
The acute effects of systemic arterial hypertension are a result of vasospasm to autoregulate perfusion. The chronic effects of hypertension are caused by arteriosclerosis and predispose patients to visual loss from complications of vascular occlusions or macroaneurysms.
How to treat hypertensive retinopathy?
The only treatment for hypertensive retinopathy is lowering your high blood pressure. You may be able to reverse the damage because the retina can heal, but this depends on how severe the damage is. 4
How to diagnose retinopathy?
No matter what the cause is, retinopathy is diagnosed through an eye exam by an optometrist, a doctor who focuses on eye care. They can tell how well your eyes are working and identify any damage to the muscles and blood vessels in your eyes. 5
How is diabetic retinopathy similar to hypertensive retinopathy?
Both cause damage to the retina, but they have different causes. Diabetic retinopathy is caused by high blood sugar. Hypertensive retinopathy is caused by high blood pressure. Both conditions are diagnosed by an eye doctor. Treatment options may include surgery, laser treatments, or eye injections. Your healthcare provider may also recommend watching your condition more closely without treatment. Controlling your blood sugar and blood pressure is the only way to prevent retinopathy.
What is the condition where the retina becomes damaged?
Retinopathy is a condition where the retina becomes damaged. The retina sends signals to your brain that help you see images. When retinopathy is untreated, it can cause blindness. Hypertensive and diabetic are two types of retinopathy. While both cause damage to the retina, they have different causes. 1
How to treat retinopathy?
Treatments for retinopathy may include eye injections, laser treatment, or surgery. A low salt diet, exercise, and diabetes and hypertension management will also help.
How to prevent diabetic retinopathy?
Controlling high blood sugar will help prevent diabetic retinopathy. This means getting regular exercise, taking your diabetes medications correctly, and eating a healthy diet. Sometimes when you do everything right, your blood sugar may still be hard to control. In that case, your healthcare provider may need to change your treatment plan to get your blood sugar back in control. 3
Why do my eyes bleed?
High blood sugar creates blockages in the blood vessels of your eyes and causes them to bleed. Your eyes grow new blood vessels to compensate for this, but they are weaker and will begin to bleed as well. 3
What is Retinopathy?
Retinopathy means that disease has damaged the retina. The retina is the part inside the eye that senses light. Different diseases can cause retinopathy. There can be partial or complete loss of vision. Retinopathy can develop slowly or suddenly, can get better on its own or lead to permanent damage.
Why does central serous retinopathy cause blurred vision?
In this condition, fluid accumulates in the membrane behind the retina. The fluid seeps in between layers of the retina and causes them to separate. This results in blurred vision or poor night vision.
What causes retinal detachment?
Proliferative retinopathy can cause retinal detachment. This is a separation of the layers of the retina. It is one of the most serious consequences of proliferative retinopathy. The vitreous is the clear gel between the lens and the retina. Sudden bleeding into the vitreous can obscure vision, often quite suddenly.
How long does it take for diabetic retinopathy to develop?
It takes years to develop. Two kinds of diabetic retinopathy have the potential to diminish vision: In nonproliferative retinopathy, blood vessels in the retina deteriorate. Deteriorating blood vessels can become blocked or deformed. Fluids, fats and proteins leak out of the abnormal blood vessels.
How long does it take for central serous retinopathy to go away?
Central serous retinopathy — Most cases go away without any treatment within three to four months. Full vision can return within six months.
Why is my eye white?
He or she looks for pale or white areas of the retina. These areas are pale because they are not getting enough blood. The doctor also may see bleeding from ruptured blood vessels or swelling of the retina or optic nerve.
How to prevent diabetic retinopathy?
Diabetic retinopathy — Controlling blood sugar and blood pressure are essential to prevent diabetic retinopathy. Annual eye exams are crucial for people with diabetes. If you have diabetic retinopathy, you should have more frequent eye exams. Treatment can start before sight is affected, which helps prevent vision loss.
