The retinal disease associated with high blood pressure (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 high blood pressure retinal disease?
An advanced stage of chronic retinal changes is referred to as hypertensive retinopathy (retinal disease associated with high blood pressure), which can lead to permanent damage to the retina. See phonecations for All You Need to Know About Methanol Poisoning.
The retina 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 crucial for vision, is supplied by thin arterial blood vessels that can be damaged by high blood pressure, so that the retina can no longer be adequately supplied.
The extent of retinal damage depends on the duration and severity of the high blood pressure, whether the hypertension is due to other diseases, and the age at which the high blood pressure appears. High blood pressure can cause retinal disease when the normal blood pressure values of 140/90 mmHg are repeatedly or permanently exceeded.
Hypertensive retinal disease can be acute or chronic. The possibility of acute retinopathy exists when there is a sudden increase in blood pressure when hypertension is already present (“essential” or “primary” hypertension).
The “secondary” form of retinopathy, which is found in fewer numbers but is more difficult to control, is based on another disease. These include diseases of the kidneys (renal hypertension) or kidney vessels that may be narrowed or blocked. Hypertension can also lead to retinopathy if the tumor type pheochromocytoma develops or in the later course of pregnancy.
In the case of eclampsia, which mainly occurs in the last trimester of pregnancy, the preliminary stage of which is known as preeclampsia, cramps occur, which are preceded by a rapid rise in blood pressure, headaches and blurred vision. The affected pregnant woman can then develop retinal disease due to high blood pressure (“eclamptic retinopathy”).
Symptoms, Ailments & 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 can indicate acute damage to the retina. It is an internal emergency that requires immediate treatment, including the involvement of an ophthalmologist. Other complaints, symptoms and signs of retinal damage from high blood pressure can include dizziness, nausea and severe headaches.
The severity of the visual disturbances depends directly on the extent of the retinal damage. If the retinal damage is very pronounced and if the cause, i.e. the excessively high blood pressure, is not treated adequately, there can ultimately be a risk of blindness. In patients with chronic high blood pressure, the retinal damage can also be asymptomatic, which means that good vision can also be present for a longer period of time.
However, if hypertensive retinopathy continues to progress without treatment, visual disturbances and increasing visual impairments in both eyes are the inevitable consequences. Serious complications with retinal damage caused by hypertension have become rarer due to constant advances in diagnostic and therapeutic options.
Diagnosis & History
With a fundoscopy or ophthalmoscopy, an ophthalmologist can use a light source and a magnifying glass to detect diseases of the retina at the back of the eye (fundus) after the pupils have been dilated by instilling drops in the eyes.
After the patient places the chin on a support, the eyes are sequentially illuminated with a thin beam of light. Under a microscope and magnifying glass, details of the retina (such as the blood vessels, the exit point of the optic nerve, the central point of sharpest vision, and the choroid) can be viewed in three dimensions. After dilating the pupils, the edges of the retina can be viewed. After the examination, you will be unfit to drive for six hours.
The retinal disease in high blood pressure is divided into four stages: In stage 1, slight constrictions of arterial vessels are diagnosed. In grade 2, either clear narrowing or different narrowing and widening (so-called caliber fluctuations) of vessels can be observed.
Im Grad 3 werden zusätzlich Ödeme (Flüssigkeitsansammlungen), flaumförmige Zellbereiche, deren Funktion wegen Nervenfaserinfarkten eingeschränkt ist sowie streifenartige Netzhauteinblutungen festgestellt. Im Erkrankungsgrad 4 ist bei Netzhauterkrankung bei Bluthochdruck zudem der Sehnerv an seiner Austrittsstelle geschwollen.
If left untreated, the retinal disease associated with high blood pressure can lead to poor eyesight and even blindness. In the case of acute peaks in blood pressure, the retinal damage develops much faster than in the case of chronically high blood pressure. The eye damage occurs here suddenly with massive visual disturbances, which if left untreated can quickly lead to blindness. Sudden visual disturbances are an indication of acute high blood pressure for the doctor. However, this condition represents a medical emergency and requires urgent medical attention.
In addition to the sudden visual damage, dizziness, nausea, massive headaches, sensory disturbances, paralysis, chest pain or shortness of breath can occur. These symptoms indicate that other organs are also affected due to the sudden spikes in blood pressure. If treatment is not started immediately, there is also a risk of a stroke or heart attack. The cause can be a derailed primary high blood pressure.
Sometimes, however, it is also a sudden onset of secondary high blood pressure, which can be traced back to kidney disease, among other things. Hypertensive crises can also result from complications of pregnancy. So-called preeclampsia can develop in late pregnancy, which can lead to high blood pressure crises.
The retinal damage caused by chronic high blood pressure or by acute high blood pressure crises can improve again when the blood pressure returns to normal. However, chronic retinal damage often remains, which reacts sensitively to any form of high blood pressure. Although total blindness has become rare today due to good therapy standards, it cannot be completely ruled out.
When should you go to the doctor?
If people suffer from high blood pressure, it should always be examined and checked by a doctor at regular intervals. The general state of health must be documented in the check-ups so that impending irregularities can be reacted to immediately.
If there are any abnormalities or sudden changes in the eyesight of these high-risk patients, another visit to the doctor is necessary. In these cases, there is a need for quick action, because without immediate and extensive medical care, the person affected is at risk of going blind. Dizziness, unsteady gait, nausea or vomiting are signs that should be investigated. Headaches or anxiety can develop at the same time and should be discussed with a doctor. An increased risk of accidents or falls must be presented to a doctor.
If there are unusual disturbances in visual perception or reduced vision, a doctor must be consulted. Blurred vision or changes in color perception should be evaluated and treated. An inability to clearly visualize movement or outlines of people or objects is a concern. If the vision deteriorates within a few minutes or hours, a doctor must be consulted as soon as possible. If the person concerned 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 doctor should be consulted.
Treatment & Therapy
The retinal disease associated with high blood pressure must be treated with a systematic reduction in blood pressure. Blood pressure can be lowered by administering antihypertensive drugs or by making lifestyle changes.
Adjusting lifestyle habits should be the priority. This includes reducing any existing excess weight and stopping cigarette consumption. A reduction of low-fat, low-salt and low-meat nutritional components in favor of fish, fruit and vegetables should be made. Alcohol consumption is to be limited. Physical activity should be at least three times a week for 30 minutes.
However, medication is often required, since hypertensive retinopathy indicates that the high blood pressure has been affecting the retina for a long time. Drugs that lower blood pressure include diuretics (preparations that drain water) and beta- blockers. In the case of particularly severe hypertension, treatment is carried out in a clinic and, in an emergency, in intensive care. If another disease is causing the high blood pressure, then that disease must be treated.
If a high blood pressure patient already had hypertension before the pregnancy, a switch to suitable medication takes place. A particularly close care by the gynecologist takes place in case of signs of preeclampsia (e.g. moderate increases in blood pressure). In the case of retinal disease caused by high blood pressure in the form of eclampsia, only premature delivery may be able to avert dangerous complications for mother and child.
Outlook & Forecast
The further course of the disease depends on the extent of the disorders suffered. With long-lasting and high blood pressure, the prognosis is significantly worse. There has been irreparable damage to the retina that cannot be regenerated. The affected person is dependent on medical care for life so that an alleviation of the symptoms can be documented.
In some cases, surgery is necessary to improve vision. If the course of the disease is unfavorable, blindness occurs and thus severe limitations in coping with everyday life. Due to the associated emotional stress, blindness can lead to secondary disorders and mental illnesses. If the course of the disease is favorable, visual aids can be used that lead to improved visual perception.
The decisive factor for the further course of the disease and the prospect of an improvement in the overall situation is the patient’s willingness to change. Lifestyle must be optimized so that the symptoms do not increase. In particular, the diet should be improved and the consumption of harmful substances should be completely avoided. Otherwise, despite all efforts, there will be a continuous deterioration in health. It should be noted that persistent high blood pressure puts strain on the circulatory system. A medical emergency can therefore develop at any time.
A retinal disease caused by high blood pressure should be prevented by measures for early detection. Patients with diabetes mellitus, kidney disease and high blood pressure should have their heart, kidneys, blood pressure and eyes checked at regular intervals. From the age of 40, an annual eye examination is recommended.
Carrying out a cardiovascular check-up is part of the catalog of services provided by health insurance companies from the age of 35. Women who have suffered from preeclampsia in the last trimester 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.
Chronic retinal diseases caused by high blood pressure often require years of and sometimes even lifelong follow-up care. In mild cases, the retinal changes regress. However, the retina can also be irreversibly damaged. Then lengthy follow-up examinations are often necessary to prevent even greater eye damage.
A chronically diseased retina is particularly sensitive to blood pressure fluctuations. It is therefore necessary to strive for a permanent reduction in blood pressure. However, it is often not so easy to stabilize the blood pressure values despite intensive treatment, since the 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 also seek permanent ophthalmological treatment in order to counteract the risk of a worsening of the eye problems or of 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.
Eye surgery may be required to prevent blindness. Furthermore, the follow-up examinations also serve to find an individual visual aid for the patient. The visual aid may have to be adjusted as the disease progresses. In very severe cases, which lead to significant impairment of vision or even blindness, the patient may need long-term psychological support.
You can do that yourself
In the therapy of hypertensive retinopathy, the cooperation of the patient is of great importance, since antihypertensive drugs alone often do not lead to sufficient improvement. In addition to regularly taking the medication prescribed by the doctor, the patient usually has to change his or her lifestyle. At the latest with a BMI of 25 or higher, weight reduction is urgently recommended.
In addition, the diet should be changed in general. Fatty meat and sausages should be avoided completely. Other animal fats, especially butter and cream, are also not recommended. Instead, those affected should eat lots of fresh fruit and vegetables. Whole grains (noodles, rice, bread) and fermented soy products (tofu and tempeh) as well as legumes and seedlings are particularly suitable as a basis for the supply of energy and proteins. Salt intake should be reduced according to widespread opinion, although a connection between salt intake and blood pressure values cannot be established in all patients.
In addition to nutrition, sufficient physical exercise is particularly important, with endurance sports having a particularly beneficial effect on blood pressure. Five training sessions per week are recommended, at least thirty minutes each per day. Brisk walks, power walking, cycling, water aerobics and swimming are particularly suitable. Competitive sports and great physical exertion are better avoided. Alcohol should be consumed in small amounts at most. Giving up nicotine is also helpful.