High blood pressure is a serious risk factor for morbidity and mortality. The World Health Organization (WHO) defines high blood pressure as systolic blood pressure above 140 mmHg and/or diastolic blood pressure above 90 mmHg. In Germany, about 35 million people are affected.
High blood pressure can affect the eyes, especially the retina, choroid and optic nerve. It is a risk factor for the development of arterial and venous vessel occlusion, arterial macroaneurisms and non-arteriitic anterior ischemic optic neuropathy (AION). In addition, hypertension increases the risk for the development and progression of diabetic retinopathy, glaucoma and age-related macular degeneration (AMD).
High blood pressure in the eye is most frequently presented by hypertensive retinopathy. Hypertensive retinopathy is classified in different stages depending on the severity of the condition:
Keith-Wagener-Barker classification (1939):
Stage 1: Mild generalized caliber irregularities of the retinal arteries and slightly increased venous filling
Stage 2: Distinct caliber irregularities of the retinal arteries and arterio-venous crossing signs
Stage 3: Additional retinal bleeding, hard exudates (fat deposits in the retina), cotton wool foci (white blurred spots indicating retinal capillary occlusion)
Stage 4: Additional optic nerve swelling
Classification by Wong and Mitchell (2004):
Mild: One or more of the following signs: generalized / focal reflex / caliber irregularities of the arteries, arterio-venous crossing signs
Moderate: One or more of the following characters: Retinal bleeding (spot/spot/stripe), microaneurisms, cotton wool foci, hard exudates
Severe: signs of moderate hypertensive retinopathy plus papilledema
The corresponding clinical pictures of damage to the retina (retina), choroid (choroidea) and the optic nerve (nervus opticus) are often linked (hypertensive chorioretinopathy).
Hypertensive choroidopathy is most commonly observed in younger patients with hypertension peaks. It is characterized by fibrinoid necrosis of the choroidal arteries, resulting in reduced perfusion of the choriocapillaris and focal damage to the deeper retinal layers due to oxygen deficiency.
Various imaging techniques are used in the diagnosis of ocular fundus changes in high blood pressure: colour photography,
Fundus autofluorescence (FAF), optical coherence tomography (OCT), OCT angiography, fluorescence angiography (FAG), indocyanine green angiography (ICG).
The successful treatment of hypertension and the monitoring of hypertensive changes in the ocular fundus can be achieved through the cooperation of internists / general practitioners and ophthalmologists, as well as through the detailed education and motivation of patients.
