Ocular signs of systemic hypertension: A review

Hurcomb, Peter G.; Wolffsohn, James S.; Napper, Genevieve

doi:10.1046/j.1475-1313.2001.00617.x

Cited by 13 publications

(12 citation statements)

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“…The end arteriolar system of the retinal vasculature can be observed noninvasively and is particularly susceptible to chronic changes in blood pressure. As many people have their eyes examined every 1 to 2 years, optometrists should play an important public health role in screening for systemic hypertension, performing ocular fundus examination, measuring blood pressure, emphasizing the importance of regular general practitioner assessment, and referring suspect patients for appropriate management [37,39].…”

Section: Discussionmentioning

confidence: 99%

“…In animal studies, hypertensive retinopathy has been found to appear earlier than choroidopathy or optic neuropathy [16]. Ocular signs of systemic hypertension have been divided into those considered to be indicators of premalignant (early changes, prior to significant damage to the retinal vasculature) and malignant systemic hypertension [21,39]. …”

Section: Ocular Signs Of Systemic Hypertensionmentioning

confidence: 99%

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Hypertension and the eye

Wolffsohn

Hurcomb

2002

Current Science Inc

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In addition to being the chief cause of death in developed countries, systemic hypertension is also a leading cause of visual impairment. The eye is an end arteriolar system and is therefore susceptible to changes in blood pressure. It is also the only place where blood vessels can be clearly viewed by noninvasive techniques. This paper reviews current research into premalignant and malignant retinal signs of systemic hypertension. Previous methods of classifying retinal hypertensive signs are identified, along with more recent image analysis techniques. The need for observing the retinal vasculature as well as measuring blood pressure for monitoring systemic hypertensive patients is discussed in relation to current research.

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Section: Discussionmentioning

confidence: 99%

Section: Ocular Signs Of Systemic Hypertensionmentioning

confidence: 99%

Hypertension and the eye

Wolffsohn

Hurcomb

2002

Current Science Inc

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“…Esto conlleva una pérdida de la capacidad de autorregulación, con dilatación de las arteriolas y pérdida de las uniones entre las células endoteliales y pericitos, con disrupción de la barrera hemato-retiniana, aumentando la permeabilidad de los vasos y extravasación de elementos formes sanguíneos a nivel intra-retiniano y superficial. En otros casos cuando la instauración de la HTA es de forma brusca no se producen fenóme-nos de adaptación por lo que se produce una rotura de todo el espesor de la pared del vaso dando lugar a hemorragias intraretinianas profundas 5,6 . Las hemorragias se clasifican en:…”

Section: Signos De La Retinopatía Hipertensiva Hemorragiasunclassified

“…En algunos casos son difíciles de observar al quedar ocultas por las alteraciones del epitelio pigmentario de retina o el edema retiniano difuso. Es importante señalar que cuando existen lesiones a nivel coroideo (coroidopatía hipertensiva) estamos ante un caso avanzado o maligno de la HTA que suele asociar insuficiencia renal [5][6][7] .…”

Section: Hemorragias Coroideasunclassified

Manifestaciones oftalmológicas de la hipertensión arterial

Rodriguez

Zurutuza

2008

Anales Sis San Navarra

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RESUMENLa hipertensión arterial sistémica (HTA) es una de las enfermedades más frecuentes en los países industrializados, llegando su incidencia hasta un 30%, cifra que va en aumento por la mayor esperanza de vida de la población. Esta elevación de la presión arterial ocasiona o acelera los cambios en la pared vascular de los órganos diana como el riñón, cerebro, corazón y ojo.A nivel ocular, la HTA produce lesiones en la retina, la coroides y cabeza del nervio óptico, pudiendo abarcar un amplio rango de lesiones, desde un estrechamiento vascular leve hasta una pérdida visual severa por neuropatía óptica isquémica. La respuesta primaria de las arterias retinianas a la hipertensión arterial sistémica es un estrechamiento vascular y los signos que aparecen en el fondo de ojo en la retinopatía hipertensiva son la vasoconstricción difusa o focal, la extravasación por permeabilidad vascular aumentada y la arteriolosclerosis con engrosamiento de la pared de los vasos. Estas tres entidades son las responsables de la aparición de diferentes lesiones que van a caracterizar los estadíos de la enfermedad retiniana como son: los cruces arteriovenosos, exudados duros y algodonosos, trombosis, embolias, hemorragias en el parénquima retiniano, desprendimiento seroso de retina, edema de papila y neuropatía óptica isquémica en los casos más severos como el caso de la hipertensión arterial maligna.Palabras clave. Hipertensión arterial. Retinopatía hipertensiva. Exudados retinianos. Cruces arteriovenosos. ABSTRACTSystemic Arterial hypertension (AHT) is one of the most frequent diseases in the industrialised countries, with an incidence reaching 30%, a figure that is rising due to the greater life expectancy of the population. This rise in arterial tension causes, or accelerates, changes in the vascular wall of the target organs such as the kidney, brain, heart and eye.At the ocular level, AHT produces lesions in the retina, the choroids and optic nerve head; this can include a wide range of lesions, from slight vascular narrowing to severe visual loss due to ischaemic optical neuropathy.The primary response of the retinal arteries to systemic arterial hypertension is vascular narrowing and the manifestations that appear at the back of the eye in hypertensive retinopathy are diffuse or focal vasoconstriction, extravasation due to increased vascular permeability and arteriosclerosis with swelling of the wall of the vessels. These three entities are responsible for the appearance of different lesions that characterise the stages of the retinal disease, which are: arteriovenous crossings, hard and cottonlike exudates, thrombosis, embolisms, haemorrhages in the retinal parenchyma, vitreous detachment from the retina, papilla edema and ischaemic optical neuropathy in the more severe cases, such as in case malign arterial hypertension.

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“…For these reasons, some patients are not diagnosed with hypertension until after experiencing problems in visual acuity. If a referral is made on the presence of malignant hypertensive retinopathy, irreparable damage to the vascular system of the body as a whole has already occurred, thereby limiting treatment efficacy [16]. Thus, early detection of vasculopathy and, in turn, early disease management, presents the greatest potential for reducing morbidity and mortality associated with hypertension.…”

Section: Introductionmentioning

confidence: 99%

Real-time studies of hypertension using non-mydriatic fundus photography and computer-assisted intravital microscopy

O’Brien

Banerjee

et al. 2013

Clinical Hemorheology and Microcirculation

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Hypertension is asymptomatic until late stages of pathogenesis, rendering an effective means of detection for early diagnosis essential. The current method of diagnosing hypertension requires two or more sphygmomanometric readings over two or more office visits, which potentially hinders early detection. Though retinopathy is an indicator of vascular damage, it generally presents in later stages of hypertension. Previous and related studies have suggested that the microvasculature in the bulbar conjunctiva may be a sensitive site to assess vasculopathy. Conjunctival microangiopathy was assessed using CAIM and reported on a severity index (SI). Images of the retinal fundus were taken via non-mydriatic fundus photography and graded using the Scheie scale in the same subjects to compare with CAIM. Conjunctival microangiopathy was significantly elevated in hypertensive subjects (SI = 5.35 ± 1.04, n = 20) compared to control subjects (SI = 1.75 ± 1.39, n = 8; p ≤ 0.05), and correlated with time since disease diagnosis (R 2 = 0.33). Hypertensive subjects with Grade 1 retinopathy displayed increased conjunctival microangiopathy (SI = 5.85 ± 0.90, n = 13) compared to those without retinopathy (SI = 4.43 ± 0.53, n = 7; p ≤ 0.05). These data indicate a possible pre-retinopathy time window during which conjunctival microangiopathy may indicate the risk of organ damage, supporting the hypothesis that the conjunctival microcirculation may serve as a platform for early detection and monitoring disease progression.

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Ocular signs of systemic hypertension: A review

Cited by 13 publications

References 64 publications

Hypertension and the eye

Hypertension and the eye

Manifestaciones oftalmológicas de la hipertensión arterial

Real-time studies of hypertension using non-mydriatic fundus photography and computer-assisted intravital microscopy

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