High blood pressure is a chronic condition that can damage vital organs such as the brain, heart, kidneys, and eyes. It develops gradually, causing tissue damage until the adverse effects on the organs become clinically apparent.
The retina is the only location in the body where we can see the blood vessels clearly using ophthalmoscopy, a simple and non-invasive procedure. It allows for the comparison of injury to the back of the eye with damage to other areas of the body.
Hypertensive retinopathy is a set of ocular symptoms caused by elevated blood pressure in the retina. The higher the blood pressure and the longer the evolution time, the more likely the eye and the rest of the body would be severely damaged.
Arteriosclerosis, advanced age, diabetes, high cholesterol, and smoking are all other factors that can aggravate hypertensive retinopathy.
The severity of retinopathy is also determined by the retinovascular tree and the time it takes to achieve low blood pressure. We can tell the difference between chronic and acute hypertension.
Retinopathy Caused by Chronic Hypertension
This variant affects the vast majority of patients. They normally have no symptoms at first, but when their blood pressure increases, they develop vision issues. They’re discovered by chance during an inspection of the back of the eye, where the following findings are discovered:
1. A drop in vascular calibre, which can be diffuse or focal.
2. Arteriovenous crossings that are pathological (an artery compressing a vein, inhibiting blood flow).
3. Variations in the vascular reflex (difficulty visualising the blood inside the vessels).
4. Micro and macro aneurysms in the retina (abnormal vascular dilation both small and large respectively).
Acute Hypertensive Retinopathy, Also Known as Malignant or Accelerated Retinopathy
It comes out of nowhere and is characterized by elevated blood pressure, severe headaches, and a noticeable loss of vision. We will discover the following during the clinical examination:
1. Haemorrhages in the retina, preretinal, choroidal, or vitreous (through vessel rupture)
2. Exudate (soft or hard, yellowish-white deposits from extravasation of plasma materials or from ischaemia)
3. Papillary edema (optic nerve inflammation)
4. Edema of the macula (inflammation of the central part of the retina)
Hypertensive retinopathy has no clear medication; blood pressure must be closely monitored and managed. While certain patients with poorly regulated blood pressure can experience irreversible damage and visual consequences, a decrease in blood pressure results in a substantial reduction in retinal lesions.
As a result, every hypertensive patient should have an ophthalmoscopy on a regular basis. The frequency of the ophthalmoscopy should be tailored to the severity of the hypertension, age, and the presence of other cardiovascular risk factors.