OVERVIEW
OVERVIEW
Hypertensive eye disease is defined as changes in the fundus of the eye caused by blood pressure that exceeds normal values over a long period of time. Abnormal changes in the fundus are closely related to the age of the patient; the older the patient, the more pronounced the changes. The extent of fundus changes is directly proportional to the duration of the disease.
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Department
Ophthalmology, Retina Vitreous Disease, Fundus Disease, Cardiovascular Medicine, Endocrinology
Clinical symptoms
There may be loss of vision, with retinal artery constriction, retinal and optic disc pathology, retinal hemorrhage, optic disc edema, and fundus hemorrhage as the main manifestations.
Hazards
The more severe the fundus changes, the worse the prognosis.
Complications
Fundus hemorrhage, acute angle-closure glaucoma, visual deterioration, optic nerve atrophy, etc.
Examination
Visual function examination, slit lamp examination, ophthalmoscope examination, physical examination, renal function examination, electrocardiogram examination, vascular ultrasonography, angiography, fundus angiography, etc.
Diagnosis
A history of hypertension, retinal artery constriction, retinal hemorrhage, and optic disc edema on funduscopic examination, combined with funduscopic angiography, can lead to the diagnosis.
Treatment principle
Actively treat the primary disease causing hypertension, and alleviate the fundus changes symptomatically.
Curative
Symptoms can be relieved and prognosis can be improved.
Dietary recommendations
Low-salt, low-fat, low-sugar diet, and adjust the diet according to the condition.
Important Reminder
The treatment of hypertensive fundopathy should firstly lower the blood pressure.
Causes
Causes
Both primary and secondary hypertension can be caused. Secondary hypertension can be seen in a variety of diseases, such as kidney disease, endocrine disease, etc. The degree of fundopathy is closely related to the duration and severity of hypertension. The degree of fundopathy is closely related to the duration and severity of hypertension.
Symptoms and Diagnosis
Typical symptoms
1. Retinal arterial spasm stage is seen in the early stage of hypertension, with generalized or limited narrowing and bending of retinal arteries, abnormal arteriovenous ratio; straightening of arteries, sharpening of branching angle; small varicose veins after arteriovenous crossings, in particular, the small iris around the macula can be bent in the shape of a typical helix. 2. Retinal arteriosclerosis stage is mainly characterized by thinning of the arteries, reflection enhancement, and cross-pressure sign. 3. Retinopathy stage ( (1) Hemorrhage: superficial hemorrhage is linear, flame-like or flaky, while deep hemorrhage is mostly dot-like or round block-like. (2) Exudates: soft exudates, flocculent exudates of varying sizes located on the surface of the retina. Hard exudates, located in the deeper layers of the retina, are in the form of small yellowish-white dots with clear margins. (3) macular stellate atlas: it consists of most simple or fused bright yellow-white dots. 4. retinal neuropathy stage This stage is retinopathy coupled with optic disc edema, jugular vein angulation, and arterioles are significantly thinned. 5. chorioretinopathy When the blood pressure rises sharply, the chorioretinal capillaries are damaged. Examination of the eyeglasses reveals a yellowish-white patchy exudation of three to four vascular diameters in the subretina.6. Optic disc edema is often seen in patients with acute (malignant) hypertension, representing a severe stage of hypertension. The optic disc border is blurred, the edema bulges 1 to 3 diopters, and the edema exceeds the border of the optic disc and connects to the nearby edematous retina. Prolonged periods of rapidly elevated blood pressure and severe edema can produce neural atrophy even if the edema subsides.
Diagnostic basis
1. History of hypertension. 2. Funduscopic examination reveals retinal arteriolar constriction, retinal and optic disc lesions. 3. Funduscopic angiography reveals stenosis of the retinal arterioles and capillaries. 4.
Treatment
Treatment guidelines
Actively treat the primary disease causing hypertension, and symptomatically delay fundus changes, such as controlling blood pressure and reducing optic disc edema.
Medication
For those with retinal hemorrhage, oral iodine preparations can be given to promote exudation and hemorrhage absorption. Oral sedatives, vitamin C, E, rutin, etc.
Surgery
Vitrectomy is needed for fundus hemorrhage and vitreous hemorrhage caused by hypertension.
Other treatments
Fundus examination, fundus angiography.
Prognosis
The more severe the changes, the worse the prognosis. Those whose fundus changes are dominated by atherosclerosis are prone to congestive heart failure, coronary atherosclerotic heart disease, and cerebrovascular accidents, and those who are dominated by retinopathy or optic neuroretinopathy are prone to uremia.
Nursing care
Daily care
1. Control blood pressure and blood lipid. 2. Adhere to exercise to increase the elasticity of blood vessels. 3. Adopt good work and rest habits, don’t stay up late. 4. Reasonable use of eyes, don’t use TV, computer and other electronic products for a long time. 5. Prevent infections.
Dietary management
1. Low-salt, low-fat, low-cholesterol diet, limit protein intake. 2. Eat more coarse grains, more vegetables, fruits, and drink more water. 3. Avoid smoking and alcohol.