Eye disease associated with cardiovascular disease

2021-02-02 12:00 AM

High blood pressure retinopathy is the most common cardiovascular disease that causes eye damage. Damage to the retina results from hardening of the vascular wall and vasoconstriction.

The eyes are closely related to the other organs of the body. Many systemic diseases with eye manifestations and many eye conditions may be signs of systemic illness.

For many patients, eye exam not only allows the detection of eye lesions caused by systemic disease but also helps to confirm diagnosis, prognosis or evaluate the results of systemic treatment.

Eye damage can be seen in many cardiovascular diseases such as high blood pressure, atherosclerosis, heart valve disease, endocarditis. The most common is an injury to the retina.

Retinopathy caused by high blood pressure

High blood pressure retinopathy is the most common cardiovascular disease that causes eye damage. Damage to the retina results from hardening of the vascular wall and vasoconstriction.

The hardening of the vessel wall causes the wall of the vessel to thicken: manifested by a sign of widespread arterial light and changes at the dynamic-venous cross. During fundoscopy, a normal artery always has a small white line in the middle due to reflected light (artery light), the artery light becomes wider as the wall thickens, in the late stages of the light. the artery occupies almost the entire artery width (copper wire image), eventually the artery is replaced by a white line (silver wire image). At the arterial-venous cross-section due to hardening and increasing arterial pressure, squeezed and dilated veins before and after the intersection can cause signs of Salus. the S at the crossroads) or the Gunn sign (the vein looks like it's cut in half at the crossroads, on both sides of the artery, the vein tip is pointed like a bayonet). The artery is zigzag, segmentally constricted or diffuse (in different areas of the retina). Arteriosclerosis can also be seen in the elderly who do not have high blood pressure.

Vasoconstriction caused by prolonged hypertension leads to necrosis of smooth muscles in the vascular wall and causes 4 types of damage:

Hemorrhage in the retina: shallow or deep, often flame-shaped.

Cotton stains: yellowish white spots, blurred margins, due to retinal nerve fibers necrosis.

Exudate: yellow-white stains, clear margins, usually next to blood vessels. At the posterior pole, secretions radiate around the macula like a star (macular sign).

Papillary edema: swelling of the papillae above the retinal surface, the edge of the papilla is faded. Papillary edema is a sign of late stage, severe prognosis.

For the evaluation and prognosis of retinopathy caused by high blood pressure, many different types of diseases are used. Classification (Keith and Wagener), although long-standing, is still widely applied due to its simplicity and practicality. This classification is mainly based on changes in the retinal blood vessels:

Stage 1: The artery contracts slightly.

Stage 2: abnormal arterial-venous cross sign, zigzag veins, wide arterial light, Salus sign.

Stage 3: arteries contract a lot, haemorrhage, cotton nodules, discharge, Gunn signs.

Stage 4: spiny edema plus signs of stage 3.

High blood pressure retinopathy can lead to complications: dark retinal infarction (Elschnig's stain), retinal serous detachment, aneurysm, occlusion or central retinal artery.

Other cardiovascular diseases

In addition to high blood pressure retinopathy, other cardiovascular diseases such as atherosclerosis, heart valve disease, and endocarditis can form a clot or narrow blood vessel diameter, leading to complications. in the eye such as transient blindness (amaurosis fugax), obstruction of the central artery of the retina or the central vein of the retina.