Retinal disease in hypertension (hypertensive retinopathy) occurs when high blood pressure (hypertension), which basically affects all organs of the human body, leads to changes in the retina.
What is retinal disease in hypertension?
An advanced stage of chronic retinal changes is called hypertensive retinopathy (retinal disease in hypertension), which can lead to permanent damage to the retina. The retina, located at the back of the eye, has special sensory cells (photoreceptors) that transmit color and light impulses to the brain via nerve cells. The retina, which is thus crucial for vision, is supplied by thin arterial blood vessels, which can be damaged in the case of high blood pressure, so that the supply of the retina is no longer sufficiently guaranteed. The extent of retinal damage depends on the duration and severity of the hypertension, as well as on whether the hypertension is due to other diseases and at what age the hypertension appears. Retinal disease in hypertension can develop when normal blood pressure levels of 140/90 mmHg are repeatedly or persistently exceeded.
Causes
Retinopathy in hypertension can occur in an acute or chronic form. The possibility of acute retinopathy exists when there is a sudden increase in blood pressure with preexisting hypertension (“essential” or “primary” hypertension). The “secondary” form of retinopathy, which is encountered in smaller numbers but is more difficult to control, is due to other disease. This includes diseases of the kidney (renal hypertension) or renal vessels, which may be narrowed or occluded. Hypertonia can also lead to retinopathy if the tumor type pheochromocytoma is formed or in the later course of pregnancy. In eclampsia, which occurs mainly in the last trimester of pregnancy and whose preliminary stage is called preeclampsia, cramps preceded by a rapid rise in blood pressure, headaches and blurred vision occur. The affected pregnant woman may then develop retinal disease in hypertension (“eclamptic retinopathy”).
Symptoms, complaints, and signs
All forms of high blood pressure can lead to serious damage to the retina of both eyes in the long term. These changes usually occur gradually in chronic hypertension. In an acute hypertensive crisis with very high blood pressure values, however, the retina can also be irreversibly damaged very suddenly. Sudden visual disturbances in the context of a hypertensive crisis may indicate acute damage to the retina, it is an internal emergency, which requires immediate treatment, including ophthalmological care. Other complaints, symptoms and signs of retinal damage due to high blood pressure may include dizziness, nausea and severe headaches. The degree of visual disturbance depends directly on the extent of retinal damage. If the retinal damage is very pronounced and the cause, i.e. the excessively high blood pressure, is not adequately treated, blindness may be the final consequence. In patients with chronic hypertension, the retinal damage can also be asymptomatic, which means that good vision can still be present for a longer period of time. However, if hypertensive retinopathy progresses untreated, then visual disturbances and increasing visual impairment of both eyes are inevitable consequences. Serious complications with retinal damage due to hypertension have become less common due to steady progress in diagnostic and therapeutic options.
Diagnosis and progression
With ophthalmoscopy (funduscopy or opthalmoscopy), an ophthalmologist can detect diseases of the retina located in the posterior segment of the eye (fundus) in retinal disease due to hypertension using a light source and a magnifying glass after dilating the pupils by instilling drops on the eyes. After the patient rests the chin on a support, the eyes are successively illuminated with a thin beam of light. Under the microscope and magnifying glass, details of the retina (such as the blood vessels, the exit site of the optic nerve, the site of sharpest vision located in the center, and the choroid) can be viewed in three dimensions.After dilating the pupils, the edges of the retina can be viewed. After the examination, the patient is unable to drive for six hours. Retinal disease in hypertension is divided into four stages: In grade 1, mild narrowing of arterial vessels is diagnosed. In grade 2, either marked constrictions or different constrictions and dilations (so-called caliber variations) of vessels are observed. In grade 3, additional edema (fluid accumulation), fluffy cell areas whose function is restricted due to nerve fiber infarctions, and stripe-like retinal hemorrhages are observed. In grade 4 disease, retinal hypertension also causes the optic nerve to be swollen at its exit site.
Complications
Retinal disease in hypertension can lead to visual impairment and even blindness if left untreated. With acute spikes in blood pressure, retinal damage develops much more rapidly than with chronic high blood pressure. In this case, the eye damage develops suddenly with massive visual disturbances that can quickly lead to blindness if left untreated. For the physician, sudden visual disturbances are an indication of acute high blood pressure. However, this condition represents a medical emergency and requires urgent emergency medical treatment. In addition to the sudden visual damage, dizziness, nausea, massive headache, numbness, paralysis, chest pain or shortness of breath may occur. These symptoms indicate that other organs are already affected due to the sudden spikes in blood pressure. If treatment is not started immediately, there is also a risk of stroke or heart attack. The cause may be a derailed primary hypertension. Sometimes, however, it is also a sudden onset of secondary hypertension due to kidney disease, among other things. Hypertension crises can also result from complications of pregnancy. For example, so-called preeclampsia can develop in late pregnancy, resulting in hypertension crises. Retinal damage caused by chronic high blood pressure or acute hypertensive crises may improve when blood pressure returns to normal. However, chronic retinal damage often remains, which is sensitive to any form of hypertension. Although complete blindness has become rare today because of good therapeutic standards, it cannot be completely ruled out.
When should you see a doctor?
If people suffer from high blood pressure, it should generally be examined and checked by a doctor at regular intervals. The general state of health should be documented in the control examinations so that immediate action can be taken in the event of impending irregularities. If abnormalities or sudden changes in vision occur in these high-risk patients, a further visit to the doctor is necessary. In these cases, there is a need for quick action, since without immediate and extensive medical care, there is a risk of blindness of the affected person. Dizziness, unsteadiness of gait, nausea or vomiting are signs that should be followed up. Headaches or anxiety may develop in parallel and should be discussed with a physician. An increased risk of accidents or falls must be presented to a physician. If unusual disturbances in visual perception or decreased vision occur, a physician must be consulted. Blurred vision or changes in color perception should be investigated and treated. An inability to clearly visualize movement or outlines of people as well as objects is cause for concern. If vision deteriorates within minutes or hours, a physician should be consulted as soon as possible. If the affected person reports a black curtain in front of the field of vision or a feeling of a swarm of insects in front of the eye, a physician should be consulted.
Treatment and therapy
Retinal disease associated with hypertension must be treated with systematic lowering of blood pressure. Blood pressure reduction can be achieved by administering antihypertensive medications or by lifestyle modification. Adjustment of lifestyle habits should be the primary focus. This includes reducing any existing excess weight and stopping cigarette consumption. A reduction of food components low in fat, salt and meat in favor of fish, fruit and vegetables should be undertaken.Alcohol consumption should be limited. Physical activity should take place at least about three times a week for 30 minutes. Often, however, medication is also needed, as hypertensive retinopathy indicates that high blood pressure has been affecting the retina for some time. Medications used to lower blood pressure include diuretics and beta-blockers. In the case of particularly severe hypertension, treatment is carried out in a clinic and, in an emergency, with intensive medical care. If another disease is the cause of the hypertension, this disease must be treated. If a hypertensive patient already had hypertension before pregnancy, she will be switched to suitable medication. Particularly close care is provided by the gynecologist if there are signs of preeclampsia (e.g., moderately severe increases in blood pressure). In the case of retinopathy due to hypertension in the form of eclampsia, possibly only premature delivery can avert dangerous complications for mother and child.
Outlook and prognosis
The further course of the disease depends on the extent of the disorders suffered. In the case of prolonged and high hypertension, the prognosis is significantly worse. Irreparable damage to the retina has occurred and cannot be regenerated. The affected person is dependent on medical care for the rest of his or her life, so that relief from the symptoms can be documented. In some cases, surgical interventions are necessary to achieve an improvement of vision. In the case of an unfavorable course of the disease, blindness occurs and with it a severe restriction in coping with everyday life. Blindness can lead to secondary disorders and mental illness due to the emotional stress that accompanies it. If the course of the disease is favorable, visual aids can be used that lead to improved visual perception. A decisive factor for the further course of the disease and the prospect of an improvement in the overall situation is the willingness of the affected person to change. Lifestyle must be optimized to prevent an increase in symptoms. In particular, the diet must be improved and the consumption of harmful substances must be completely avoided. Otherwise, despite all efforts, there will be a continuous deterioration of health. It should be taken into account that persistent high blood pressure leads to stress on the circulatory system. Therefore, the development of a medical emergency may also occur at any time.
Prevention
Retinal disease due to hypertension should be prevented by early detection measures. Patients with diabetes mellitus, kidney disease, and hypertension should have their heart, kidneys, and blood pressure checked at regular intervals, as well as their eyes. From the age of 40, an annual eye examination is recommended. A cardiovascular check-up is covered by health insurance from the age of 35. Women who have suffered from preeclampsia in the last third of pregnancy should have their heart and circulation checked regularly from the age of 40 because of the proven increased risk of hypertension, in order to prevent retinal disease caused by high blood pressure.
Follow-up
Chronic retinal disease from high blood pressure often requires years and sometimes lifelong follow-up care. In mild cases, the retinal changes do regress. However, the retina can also be irreversibly damaged. In such cases, lengthy follow-up examinations are often necessary to prevent even greater eye damage. A chronically diseased retina is particularly sensitive to blood pressure fluctuations. Therefore, it is necessary to strive for a permanent reduction of blood pressure. However, it is often not so easy to stabilize the blood pressure values despite intensive treatment, since hypertension can have different causes. Sometimes it even takes several years for the doctor to find a suitable combination of drugs to lower blood pressure. At the same time, however, the patient should seek permanent ophthalmological treatment to counteract the risk of worsening eye problems or blindness. The retinal changes should be constantly monitored by the ophthalmologist in order to be able to initiate appropriate measures in the event of a significant deterioration. If necessary, eye surgery may be required to prevent blindness.Furthermore, the follow-up examinations also serve to find an individual visual aid for the patient. It may be necessary to adjust the visual aid in the further course of the disease. In very severe cases that lead to significant vision loss or even blindness, the patient may need long-term psychological support.
What you can do yourself
In the therapy of hypertensive retinopathy, the patient’s cooperation is of great importance, since antihypertensive drugs alone often do not lead to sufficient improvement. In addition to regularly taking the medication prescribed by a physician, the patient must usually change his or her lifestyle habits. At the latest with a BMI of 25 or higher, a weight reduction is urgently recommended. In addition, the diet should be changed in general. Fatty meat and sausages should be completely avoided. Other animal fats, especially butter and cream, are also not recommended. Instead, those affected should consume plenty of fresh fruit and vegetables. Whole grains (pasta, rice, bread) and fermented soy products (tofu and tempeh) as well as legumes and sprouted grains are particularly suitable as a basis for supplying energy and protein. Salt intake should be reduced according to widespread opinion, although a correlation between salt intake and blood pressure values cannot be established in all patients. In addition to diet, adequate physical activity is particularly important, with endurance sports having a particularly beneficial effect on blood pressure. Five exercise sessions a week are recommended, each lasting at least thirty minutes a day. Especially suitable are brisk walks, power walking, cycling, water gymnastics and swimming. It is better to avoid competitive sports and great physical exertion. Alcohol should be consumed in small quantities at most. Abstaining from nicotine is also helpful.
