Fundus hypertonicus
| Classification according to ICD-10 | |
|---|---|
| H35.0 | Retinopathies of the fundus and changes in the retinal vessels |
| ICD-10 online (WHO version 2019) | |
The term fundus hypertonicus describes the chronic vascular changes in the retina of the eye as a result of high blood pressure . From stage III (see below) one speaks of the rare maximum form, hypertensive retinopathy : Here, an excessive increase in high blood pressure (high blood pressure crisis) can even lead to permanent damage to the retina.
Symptoms
The retinal vessel changes in the context of a fundus hypertonicus usually do not lead to a reduction in vision and are therefore not perceived by the person concerned. On the other hand, hypertensive retinopathy can be accompanied by a decrease in visual acuity or deficits in the visual field ( scotoma ).
Diagnosis
The ophthalmologist can demonstrate the change in the retina by means of an ocular fundus reflection or a vascular imaging of the retina with a dye (fluorescence angiography). There are different constrictions of the arteries with an increase in the vascular wall reflex. Depending on the extent and duration of the changes, a fundus hypertonicus can be divided into four different degrees of severity, from stage III onwards one also speaks of hypertensive retinopathy:
- Stage I: functional vascular changes with arteriolar vasoconstriction and slightly increased vein filling
- Stage II: pronounced constriction of the vessels with fluctuations in caliber. At arteriovenous crossing points: the vein crosses at an obtuse angle or dips into the retinal tissue at the crossing point (Salus sign), copper wire arteries
- Stage III: Gunn's sign , streaky bleeding, cotton-wool spots (white spots in the back of the eye), hard exudates (fat deposits)
- Stage IV: papillary swelling, silver wire arteries
therapy
A consistent adjustment of the high blood pressure to normal values is recommended as a causal therapy (see article on high blood pressure ). Fundus changes can persist despite normalization of the blood pressure values. Only in rare cases, in the context of hypertensive retinopathy, may an operation (e.g. vitrectomy ) be necessary.
causes
The high blood pressure leads to spasm of the blood vessels. In the case of hypertensive retinopathy, excessive increases in high blood pressure can result in leakage of fluid or blood into the retina or vitreous humor. The retina can also be permanently damaged by a lack of oxygen (ischemia).
Fundus hypertonicus can basically occur in any type of high blood pressure. These changes are particularly common in certain types of high blood pressure: renal hypertension , pheochromocytoma , eclampsia .
If hypertensive retinopathy occurs as part of the pregnancy disease eclampsia , it is called eclamptic retinopathy .
literature
- M. Pache, T. Kube, S. Wolf, P. Kutschbach: Do angiographic data support a detailed classification of hypertensive fundus changes? In: Journal of Human Hypertension. Vol. 16, No. 6, 2002, ISSN 0950-9240 , pp. 405-410, PMID 12037695 .
- Fundus hypertonicus (PDF; 72 kB) - guidelines of the professional association of ophthalmologists in Germany and the German Ophthalmological Society.
Individual evidence
- ↑ Kanski et al .: Clinical Ophthalmology . 7th edition. Elsevier, S. 615 ff .
