Hypertensive retinopathy H35.0

Hypertension-induced, acute or chronic changes in the retinal vessels. Often the retinal vessels constrict temporarily or permanently. Vessels can also become increasingly "snaking", form small bulges or close up.

The vessel damage leads to supply disorders of the retina. Nerve fibres in the retina can be destroyed (nerve fibre infarction). Severe high blood pressure and pronounced retinal damage can lead to papilledema.

Depending on the extent and duration of the changes, a fundus hypertonicus can be divided into 4 different degrees of severity. From stage III on, the changes in the retina are called hypertensive retinopathy.

Clinical stages of hypertension-induced retinal vascular changes (Keith and Wagner)

• Stage I: functional vascular change with arteriolar vasoconstriction and slightly increased venous filling
• Stage II: pronounced vascularisation with calibre variations. At arteriovenous intersections: the vein crosses at an obtuse angle or dips into the retinal tissue at the intersection (Salus-Gunn intersection sign)
• Stage III: Copper wire arteries, Salus Gunn crossing signs, streaky bleeding, cotton wool stains (white spots in the fundus of the eye), macular star figure (lime splatter-like foci around the macula)
• Stage IV: papilloedema, silver wire arteries

Changes in the retina can be detected by means of an ophthalmoscopy or a fluorescence angiography. This reveals differently pronounced constrictions of the arteries with an increase in the reflex of the vascular wall.

Examination of the retina in arterial hypertension is important because the vessels and their changes can be directly observed and examined here.