blood pressure( which is discussed in more detail here) leads to
a chronic spasm of the smaller arteries, called arterioles.
This leads to accelerated hardening of these arteries
(arteriosclerosis), which in turn leads to leakage of some diseased arterial vessels
(ween as flame-shaped hemorrhages by fundoscopy) and to a lack of blood supply
in other areas of the retina (ischemic changes and infarcts).
of exudate (containing blood proteins and lipids) swelling and scarring occurs
in the area of sharpest vision (fovea) with a resulting loss of vision. There
are 4 categories
of severity that have been identified. This has significance as untreated
there would be an enormous difference
of survival as detailed in this link.
and Diagnostic Tests:
Painless and gradual loss
of vision in both eyes is what eventually occurs when blood pressure is undetected
and not controlled. The physician who looks through the ophthalmoscope or uses
the slit lamp, depending on the grade of severity of hypertensive retinopathy,
would see the kind of images
depicted here (from A to D increasing severity of hypertensive retinal
These images have over the years received strangely sounding
names like "cotton wool spots" (looks like that, due to mini-infarcts
of the retina) and "macular star" (this is a ring of exudate from the
optic disc to the fovea or macula, the area normally of sharpest vision). Such
changes severely affect the vision of the person who has this finding. The most
dreaded of all hypertensive retinopathy cases is grade IV retinopathy where the
optic disc is included in the edematous process leading to "papilledema".
The reason this is so dangerous is that with this condition the central artery
and vein are both compressed effectively shutting down the circulation to the
retina. This is a medical emergency that needs to be treated in an Intensive Care
The treatment is directed at
controlling the blood pressure. In the case of "malignant hypertension",
which corresponds with papilledema and grade IV retinopathy, intravenous titration
of the blood pressure in an Intensive Care Unit setting might have to be done
in an attempt to rescue the patient's vision. Otherwise the patient will be permanently
blind. All other forms of hypertensive retinopathy are treated in the office setting,
but close blood pressure control and self blood pressure monitoring at home are
an important part of any therapy. Longterm follow-up eye examinations and longterm
blood pressure monitoring are important.