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Fundus angiopathy: causes, symptoms, treatment, recovery period and advice from an ophthalmologist. Changes in the fundus with myopia Syndromes of changes in the fundus

In fact, the fundus is what the back of the eyeball looks like when viewed from the eye. The retina, choroid and papilla of the optic nerve are visible here.

The color is formed by retinal and choroidal pigments and can vary in people of different color types (darker in brunettes and people of the Negroid race, lighter in blondes). Also, the intensity of the color of the fundus is influenced by the density of the pigment layer, which can vary. With a decrease in the density of the pigment, even the vessels of the choroid, the choroid with dark areas between them, become visible ("Parkert" pattern).

The optic disc looks like a pinkish circle or oval up to 1.5 mm in cross section. Almost in its center, you can see a small funnel - the exit point of the central blood vessels (central artery and retinal vein).

Closer to the lateral part of the disc, another bowl-like depression is rarely seen; it represents a physiological excavation. It looks a little paler than the medial part of the optic disc.

Normal fundus, on which the optic papilla (1), retinal vessels (2), fovea (3) are visualized

The norm in children is a more intense color of the optic disc, which becomes paler with age. The same is observed in people with myopia.
In some people, a black circle is observed around the optic disc, which is formed by an accumulation of melanin pigment.

The arterial vessels of the fundus look thinner and lighter, they are more straight. The venous are larger in size, in a ratio of about 3: 2, and are convoluted. After leaving the nipple of the optic nerve, the vessels begin to divide according to the dichotomous principle almost to the capillaries. In the thinnest part, which can be determined by examination of the fundus, they reach a diameter of only 20 microns.

The smallest vessels gather around the macular area and form a plexus here. Its greatest density in the retina is achieved around the macula - the area of ​​the best vision and light perception.

The very same area of ​​the macula (fovea) is completely devoid of blood vessels, its nutrition is carried out from the choriocapillary layer.

Age features

The fundus of the eye in normal newborns has a light yellow color, and the optic nerve disc is pale pink with a grayish tint. This light pigmentation usually disappears by the age of two. If a similar picture of depigmentation is observed in adults, then this indicates atrophy of the optic nerve.

The supplying blood vessels in a newborn have a normal caliber, and the efferent ones are slightly wider. If childbirth was accompanied by asphyxia, then the fundus of the eye in children will be dotted with small punctate hemorrhages along the arterioles. Over time (within a week) they dissolve.

With hydrocephalus or another reason for increased intracranial pressure in the fundus, the veins are dilated, the arteries are narrowed, and the boundaries of the optic nerve disc are blurred due to its edema. If the pressure continues to build up, the papilla of the optic nerve swells more and more and begins to push through the vitreous humor.

Narrowing of the fundus arteries accompanies congenital optic nerve atrophy. His nipple looks very pale (more in the temporal regions), but the boundaries remain clear.

Changes in the fundus in children and adolescents can be:

• with the possibility of reverse development (no organic changes);
• transitory (they can be assessed only at the moment of appearance);
• nonspecific (there is no direct dependence on the general pathological process);
• predominantly arterial (no changes in the retina characteristic of hypertension).

With age, the walls of the vessels become thickened, which makes the small arteries less visible and, in general, the arterial network appears to be paler.

The norm in adults should be assessed with an eye to concomitant clinical conditions.

Research methods

There are several methods for checking the fundus. An ophthalmic examination that looks at the fundus of the eye is called an ophthalmoscopy.

Examination by an ophthalmologist is performed when the illuminated areas of the fundus are magnified with a Goldmann lens. Ophthalmoscopy can be performed in forward and reverse form (the image will be inverted), which is due to the optical design of the ophthalmoscope device. Reverse ophthalmoscopy is suitable for general examination, the devices for its implementation are quite simple - a concave mirror with a hole in the center and a magnifying glass. Direct use is necessary when a more accurate examination is required, which is carried out with an electric ophthalmoscope. To identify structures invisible in ordinary light, the fundus is illuminated with red, yellow, blue, yellow-green rays.

To obtain an accurate picture of the vascular pattern of the retina, fluorescence angiography is used.

Why "the fundus hurts"

The reasons for the change in the picture of the fundus may relate to the position and shape of the optic disc, vascular pathology, inflammatory diseases of the retina.

Vascular diseases

The fundus most often suffers with hypertension or eclampsia during pregnancy. Retinopathy in this case is a consequence of arterial hypertension and systemic changes in arterioles. The pathological process occurs in the form of myeloelastofibrosis, less often hyalinosis. The degree of their severity depends on the severity and duration of the course of the disease.

The result of intraocular examination can establish the stage of hypertensive retinopathy.

First: small stenosis of arterioles, the beginning of sclerotic changes. There is no hypertension yet.

Second: the severity of stenosis increases, arteriovenous intersections appear (a thickened artery presses on the underlying vein). Hypertension is noted, but the state of the body as a whole is normal, the heart and kidneys are not yet affected.

Third: persistent angiospasm. In the retina there is an effusion in the form of "cotton wool lumps", minor hemorrhages, edema; pallid arterioles look like a "silver wire". Indicators of hypertension are high, the functionality of the heart and kidneys is impaired.

The fourth stage is characterized by the fact that the optic nerve swells, and the vessels undergo a critical spasm.

If the pressure is not reduced in time, then over time, occlusion of the arterioles causes a retinal infarction. Its outcome is atrophy of the optic nerve and cell death of the photoreceptor layer of the retina.

Arterial hypertension can be an indirect cause of thrombosis or spasm of the retinal veins and the central retinal artery, ischemia and tissue hypoxia.

An examination of the fundus for vascular changes is also required in case of systemic impairment of glucose metabolism, which leads to the development of diabetic retinopathy. An excess of sugar in the blood is detected, osmotic pressure rises, intracellular edema develops, the walls of the capillaries thicken and their lumen decreases, which causes retinal ischemia. In addition, microthrombus formation occurs in the capillaries around the foveola, and this leads to the development of exudative maculopathy.

With ophthalmoscopy, the picture of the fundus has characteristic features:

• microaneurysms of retinal vessels in the area of ​​stenosis;
• an increase in the diameter of the veins and the development of phlebopathy;
• expansion of the non-vascular area around the macula due to capillary overlap;
• the appearance of a solid lipid effusion and soft cotton-like exudate;
• microangiopathy develops with the appearance of couplings on the vessels, telangiectasias;
• multiple minor hemorrhages at the hemorrhagic stage;
• the appearance of an area of ​​neovascularization with further gliosis - the proliferation of fibrous tissue. The spread of this process gradually can lead to tractional retinal detachment.

Optic nerve disc

Pathology of the optic nerve head can be expressed as follows:

• megalopapilla - the measurement shows an increase and blanching of the optic disc (with myopia);
• hypoplasia - a decrease in the relative size of the optic disc in comparison with the retinal vessels (with hyperopia);
• oblique ascent - the optic nerve disc has an unusual shape (myopic astigmatism), the accumulation of retinal vessels is displaced to the nasal region;
• coloboma - a defect of the optic nerve disc in the form of a notch, causing visual impairment;
• a symptom of "morning radiance" - a mushroom-like protrusion of the optic disc into the vitreous body. Descriptions for ophthalmoscopy also contain an indication of the chorioretinal pigmented rings around the raised optic disc;
• stagnant nipple and edema - an increase in the nipple of the optic nerve, its paleness and atrophy with an increase in intraocular pressure.

The pathologies of the fundus include a complex of disorders that occur in multiple sclerosis. This disease has multiple etiology, often hereditary. In this case, the destruction of the myelin sheath of the nerve occurs against the background of immunopathological reactions, a disease develops, which is called optic neuritis. An acute decrease in vision occurs, central scotomas appear, color perception changes.

On the fundus, you can find a sharp hyperemia and edema of the optic disc, its borders are erased. A sign of optic nerve atrophy is noted - the blanching of its temporal region, the edge of the optic nerve disc is mottled with slit-like defects, indicating the onset of atrophy of retinal nerve fibers. Also noticeable is the narrowing of the arteries, the formation of couplings around the vessels, macular degeneration.

Treatment for multiple sclerosis is carried out with glucocorticoid preparations, since they suppress the immune cause of the disease, and also have an anti-inflammatory and stabilizing effect on the vascular walls. For this purpose, injections of methylprednisolone, prednisolone, dexamethasone are used. In mild cases, corticosteroid eye drops such as Lotoprednol can be used.

Retinal inflammation

Chorioretinitis are caused by infectious-allergic diseases, allergic non-infectious, post-traumatic conditions. On the fundus, they are manifested by many round formations of light yellow color, which are located below the level of the retinal vessels. At the same time, the retina has a cloudy appearance and a grayish color due to the accumulation of exudate. With the progression of the disease, the color of inflammatory foci in the fundus may approach whitish, since fibrous deposits are formed there, and the retina itself becomes thinner. The retinal vessels are practically unchanged. The outcome of retinal inflammation is cataract, endophthalmitis, exudative, in extreme cases - atrophy of the eyeball.

Diseases affecting the vessels of the retina are called angiitis. Their causes can be very diverse (tuberculosis, brucellosis, viral infections, mycoses, protozoa). In the picture of ophthalmoscopy, vessels surrounded by white exudative couplings and stripes are visible, areas of occlusion, cystic edema of the macular zone are noted.

Despite the severity of the diseases that cause fundus pathologies, many patients initially begin treatment with folk remedies. You can find recipes for decoctions, drops, lotions, compresses from beets, carrots, nettles, hawthorns, black currants, mountain ash, onion husks, cornflowers, celandine, immortelle, yarrow and needles.

I would like to draw your attention to the fact that by taking home treatment and postponing a visit to the doctor, you can miss the period of the development of the disease at which it is easiest to stop it. Therefore, you should regularly undergo an ophthalmoscopy with an ophthalmologist, and if a pathology is detected, carefully follow its prescriptions, which you can supplement with folk recipes.

Study of pathological changes in the fundus in diseases of the central nervous system, general infections and intoxications, suffering of the cardiovascular system, inflammation of the paranasal cavities, injuries, etc.

Enriches the content of ophthalmology and other branches of medicine. Currently, in everyday practice, there are a number of facts that indicate that. that diseases of the whole organism, its individual systems and organs are closely related. The interaction between individual organs and systems is carried out through the nervous system with the leading role of the cerebral cortex.

The physiological doctrine of I.P. Pavlov made it clear the significance of the so-called psychogenic factors in certain vascular diseases of the whole organism and individual organs, in particular, the eye. Thus, an increase in intraocular pressure up to an attack of glaucoma, retinal vasospasm, thrombosis, etc. often occur as a result of various emotions, especially negative ones. This chapter describes fundus changes combined by etiology. This will help young ophthadists to understand the fundus patterns they see.

Fundus changes in diseases of the central nervous system

The direct connection of the organ of vision with the central nervous system makes it possible to damage the visual apparatus in all diseases. Wherein

pathological changes in the organ of vision are manifested in the tyragkeia of both the visual centers, the visual centers and the optic nerves, and the choroid to the retina, the sensory and other nerves of the retractable apparatus of the eye and in the disorder of the innervation of the pupil.

With lesions of the visual centers, pathways and nerves, disorders of visual functions are often observed in the absence of changes in the nipple of the optic nerve. Violation of conductivity in the visual pathways is manifested by functional visual disturbances in the form of decreased visual acuity, loss of certain areas of the visual field with cattle, hemianopsia, color perception disorders, and dark adaptation. Changes in the eye diaa occurs much later than functional disorders and complements the clinical picture.

In some patients, pathological changes in the fundus are of decisive importance in the diagnosis of diseases of the nervous system (congestive nipples with a brain tumor).

In diseases of the central nervous system, the most common changes in the nipple of the optic nerve are of the type of congestive nipple, papillitis, retrobulbar neuritis and secondary descending atrophy.

F - Throne) in such patients along the course of the process differ from the usual stagnant nipples.

Complicated congestive nipples can also occur as a result of the impact of the tumor ns directly on the visual tract, and through the dilated ventricles. So the expanded third ventricle, and the anterior section associated with the chiasm, can exert pressure on the adjacent areas of the optic nerve. While "while with uncomplicated congestive nipples, both central and peripheral vision in both eyes persists for a long time and only an increase in the blind spot can be noted, with complicated congestive nipples, a change in the field of vision or a decrease in vision, a difference in visual acuity is often observed with high visual acuity in both eyes, a sharp decrease in visual acuity without atrophic changes in the nipple or atrophy of the optic nipples at the same time in both eyes.

Monitoring changes in the visual field with congestive nipples (homonymous quadrant, bitemioralia hemianopsia) is of great importance for the topical diagnosis of tumors, abscesses and other processes accompanied by an increase in intracranial pressure. The development of congestive nipples in a brain tumor depends on the location of the tumor. Most often, congestive nipples are observed with tumors in the posterior cranial fossa, very rarely - with tumors of the base of the skull and in the pituitary region. Unilateral congestive nipple rarely occurs with brain tumors, but if it develops, then with a tumor of the frontal lobe of the brain. Tumors originating from the meninges of the lesser and greater wing of the main bone such as frontal-basal arachpoidendotidomas. accompanied by early, sometimes the only eye symptoms for a long time: on the side of the disease, there is retrobulbar neuritis with central scotoma, which turns into simple atrophy of the optic nerve, later on the congestive nipple develops on the other side (Foster-Kennedy syndrome, 1911). With tumors of the pituitary region, changes in the fundus occur rather late. As a result of the pressure of a slowly growing tumor on the chiasm, a simple descending atrophy of the optic nerves occurs, which does not develop simultaneously in both eyes. With an increase in intracranial pressure in isolated cases, congestive nipples or secondary atrophy of the nipples are observed.

In tumors of the chiasmatic region, changes in the field of view are very important. Most ha-

The pacteria is bitemporalpic hemianopsia, which begins in the upper outer quadrants. Possible blindness in one eye and temporal hemiaiopsy in the other or homoimous hemiaiopsy with posterior tumor growth with damage to one of the optic nerve tracts. Radiographically, for tumors of the chiasmal region, destruction of the sella turcica is determined.

With brain abscesses, bilateral development of congestive nipples is observed, sometimes more pronounced on the side of the abscess. Nipple congestion rarely occurs in one eye (more often on the side of the abscess). With abscesses of the brain, neuritis of the optic nerve can also be often observed.

A cerebral hemorrhage rarely causes a change in the fundus. Depending on the cause of the hemorrhage (hypertension, sclerosis of the cerebral vessels, trauma), the hemorrhage in the brain may be preceded by changes in the retinal vessels: spasm of the retinal vessels, thrombosis of the central artery or vein, the phenomenon of arteriovenous crossover, copper, silver wire, sclerosis of the retinal vessels, atrophy of the visual nerves, various types of retinopathy, recurrent hemorrhages, etc.

With hemorrhages in the brain, there are simultaneously hemorrhages in the retina and preretinal, caused by the same process in the vessels of the retina as in the vessels of the brain.

Poi subarachnoid hemorrhages were observed hemorrhages around the nipple and in front of the nipple, caused. probably by leakage of blood from the subarachnoid space through the scleral canal onto the nipple and retina. Depending on the location of the cerebral hemorrhage, direct damage to the nerve fibers of one or another part of the visual tract is possible, as a result of which, in the absence of changes in the fundus, "scotomas, hemnaiupeias and other changes in the field of vision appear. With extensive hemorrhages arising from increased intracranial pressure, rarely congestive nipples were noted.

A and e in the form of basal arteries give changes in the fundus only at large sizes, as a result of which intracranial pressure increases. Compression of the optic nerve, chiasm, or spectator is also possible.

yogo path in the immediate vicinity of THEM aneurts. іmy, as a result of which there is a partial or complete atrophy of one or both nipples of the optic nerves, accompanied by changes in the visual field according to the localization of the aneurysm.

With small aneurysms of the basal arteries, usually it is not possible to detect any changes in the fundus. Only at the rupture of the aneurysm are sometimes observed changes in the fundus, which are no different from those changes that occur with hemorrhages of the Other; etiology.

Gydrocephalia - primary dropsy of the brain (fiydrocephaUis internus). An increase in the amount of fluid in the ventricles of the brain, which occurs mainly in children, in the initial stages of the disease is not accompanied by changes in the fundus; Further, there is an expansion of the retinal veins and atrophic changes in the nipple. More often there is a simple atrophy of the optic nerves due to the direct pressure of the fluid of the third ventricle on the chiasm. Sometimes it is possible to install bitemporal hemianodspyu at the same time. In some patients with hydrocephalus, as a result of an increase in intracranial pressure, stagnant nipples are found, which are distinguished by less bulging in the vitreous body than stagnant nipples with brain tumors.

With meningitis, along with damage to various parts of the eye (cycle ?, uveitis, choroiditis, and changes in the motor apparatus of the eye), the optic nerve is involved in the process. Damage to the optic nerve trunk occurs as a result of the transition of the inflammatory process from the meninges directly to the optic nerve sheaths.

With limited serous meningitis, more often of an infectious nature (influenza, pneumonia, etc.). the optic-nervous apparatus is predominantly affected - descending neuritis develops or, due to an increase in intracranial pressure, a stagnant nipple, or atrophy after them (secondary atrophy of the nipples of the optic nerves) with peripheral narrowing of the visual field.

With tuberculosis meningitis in children, when treatment with streptomycin has not yet been carried out, I G has been changed:

the fundus of the eye could hardly be detected, possibly due to the short life span of a sick child, which did not exceed 2-3 weeks in case of tuberculous meningitis. Treatment of tuberculous meningitis with streptomycin (suboccipital and intramuscular) made it possible to observe the state of the fundus for a long time.

The most frequent and severe fundus changes in tuberculous meningitis in the course of streptomycin treatment include neuritis, congestive nipples, and solitary tubercles located near the nipple, in the macular region or on the periphery. Sometimes congestive nipples are combined with solitary tubercles in one or both eyes. The presence of such changes in the fundus in tuberculous meningitis, despite treatment with streptomycin, is a warning moment, since such patients usually die.

In a basal meningitis, the inflammatory process passes from the cerebral rim to the sheaths and fibers of the optic nerve. Ophthalloscopic changes depend on the degree of involvement of the optic nipple in the inflammatory process. If the descending neuritis reaches the nipple, then a typical picture of neuritis develops with corresponding functional disorders: a decrease in central vision, defects in the peripheral parts of the field of vision, a decrease in color perception to dark adaptation. With the inflammatory process of the optic nerve in the retrobulbar part, there are no ophthalmoscopic changes for several weeks. Usually, the papillomacular bundle is affected, which is manifested by pronounced functional disorders (a sharp decrease in visual acuity, central scotoma). In the future, there is a partial atrophy of the nipple of the optic cervix.

In the inflammatory process of the paput and the other membrane of x and asm and the abdomen (optochiasmatic arachnoiditis) in the fundus it is not always possible to detect changes or they are in in the form of a subtle hyperemia of the nipple, a decrease in excavation, but sometimes a picture of neuritis of varying degrees is observed. In the future, discoloration of the temporal half of the nipple or simple atrophy of the optic nerve occurs. Functional disorders are noted before they are visible.

ophthalmoscopic changes or simultaneously WITH THEM: in some patients there are scotomas in different parts of the visual field (off-center), in others a relative or absolute central scotoma. Visual acuity gradually decreases significantly.

With iroinfections with different localization of lesions of the central nervous system, the optic nerve is relatively often involved in the inflammatory process. This is observed in encephalitis, me-on cef and l it and x, acute myelitis and eppefalomye, chitah. On the fundus, varying intensity of changes in the nipple of the optic nerve are found - from its mild hyperemia, some blurring of the boundaries, tortuosity. varicose veins to the typical congestive nipple pattern. The functions of the eyes are completely preserved, with the exception of a change in the blind spot or a sharply reduced central and peripheral vision. Specific changes in the fundus and visual functions, depending on the localization of the process, have not been established.

The visual firsts are often affected in multiple sclerosis, because of which plaques are scattered throughout the central nervous system. Especially abundant in the spinal cord. The classic form of lesion of the optic neov in multiple sclerosis is axial retrobulbar neuritis with subtle inflammatory changes in the nipple of the optic nerve.

Of the functional disorders, a relative or absolute central scotoma is characteristic. A few weeks after the onset of the disease, the temporal half of the nipple turns pale.

In multiple sclerosis, along with the classic form of axial retrobulbar neuritis, there are other diseases of the optic nerve up to a complete picture of intraocular papillitis. Accordingly, the area of ​​damage to the fibers of the visual does not change the nature of the visual impairment. In multiple sclerosis, one or both of the optic nerves are affected.

Dorsal tabes (tabes dorsalis) is a chronic syphilitic disease of the nervous system, affecting mainly the spinal cord and peripheral nerves. It is manifested by a number of characteristic pores

tissues of the organ of vision: reflex immobility of the pupils (Argill-Robertson symptom), miosis. alisocoria. less often paralysis of the oculomotor nerves. The most important manifestations of tabes include simple progressive bilateral gray atrophy of the optic nerves, often leading to complete loss of vision. Currently, tabetic atrophy of the optic nerves is much less common than in pre-revolutionary times, since there are significantly fewer fresh forms of syphilis. This is because. that patients are better and more persistently treated, and therefore diseases with tabes have significantly decreased.

More on the topic Chapter VI PATHOLOGICAL CHANGES OF THE EYEFUND IN THE DISEASE OF THE WHOLE ORGANISM, ITS SEPARATE SYSTEMS AND ORGANS:

1. Chapter IV SYMPTOMATIC THERAPY OF CACHEXIA AND OTHER METABOLIC DISORDERS IN PREVENTED MALIGNANT TUMORS
2. Chapter VI PATHOLOGICAL CHANGES OF THE EYEFUND IN THE DISEASE OF THE WHOLE ORGANISM, ITS SEPARATE SYSTEMS AND ORGANS

The delivery of nutrients to the retina is carried out with the help of blood vessels located in the fundus. The development of arterial hypertension leads to an increase in intraocular pressure. This is fraught with a decrease in visual acuity, pressing pain in the region of the eyebrows, a significant decrease in working capacity. Many people attribute migraines and “flies in front of the eyes” to fatigue, lack of sleep, or long work at the computer. The fundus of the eye in hypertensive disease may suffer due to vascular spasm. There are cases when vision deteriorates directly during a hypertensive crisis, and then recovers back.

Reasons for fundus changes

Arterial hypertension is an insidious disease that can be asymptomatic and is accidentally discovered only during a routine medical examination. Signs of fundus changes in hypertension resemble vascular inflammation caused by glaucoma, which is a local pathology.

Normal intraocular pressure is 12–22 mm Hg. Art. If, apart from changes in blood pressure, there are no other symptoms of glaucoma, we are talking about hypertension.

The development of hypertension can be provoked by:

• bad habits (alcohol, smoking, drugs);
• abuse of coffee and other tonics;
• overweight, unhealthy diet, physical inactivity;
• old age, genetic predisposition, chronic stress;
• malfunctioning cardiovascular, endocrine and nervous systems.

Diagram of the structure of the eye

The study of the fundus in hypertension is included in the list of mandatory preventive procedures, since its malignant course leads to damage to the internal organs. Together with the vessels in the retina, the cerebral arteries are affected, which is fraught with an attack of hemorrhagic stroke.

With the help of the visual analyzer, more than 80% of the information about the surrounding world is learned. Visual impairment with hypertension is one of the serious complications of the disease. High blood pressure is accompanied by vasospasm, tension of their walls, blood thickening, which is fraught with retinal infarction, the formation of microthrombi and hemorrhage.

Classification of vascular pathologies of the retina

With the help of ophthalmoscopy, even minor changes in the fundus of the eye in hypertension are diagnosed. The ophthalmologist, by the nature of the retinal vascular inflammation, establishes the etiology of the disease in order to predict its further course and select the appropriate treatment. Contrasting techniques such as angiography are sometimes allowed. Pain in the eyes, accompanied by lacrimation, can be of allergic origin, therefore it is important to differentiate the two conditions using therapeutic and ophthalmological studies.

Among the lesions of the fundus associated with a persistent increase in blood pressure, there are:

• Hypertensive angiopathy.
• Hypertensive angiosclerosis.
• Hypertensive retinopathy.
• Hypertensive neuroretinopathy.

Hypertensive neuroretinopathy

These pathologies differ in the localization of inflammation, the size of the affected focus and the level of vision loss. Damage to the optic nerve is very dangerous, since with the help of it a nerve impulse is carried out from the receptors of the retina to the occipital lobe of the brain, where the processing of the visually obtained information takes place. Changes in the eyes with hypertension gradually progress, which is fraught with negative consequences.

The above stages of development of retinal vascular lesions can pass one into another. First, there is inflammation of the ocular arteries and veins, they cannot withstand the excessive load caused by an increase in pressure in the body. Compensatory mechanisms are depleted, as a result of which tissue hardening occurs. The malignant course of the disease leads to generalized damage to the retina along with the optic nerve.

Signs of increased intraocular pressure

With cardiovascular diseases, performance and concentration levels are significantly reduced. The visual analyzer plays an important role in the implementation of various activities. Hypertension and glaucoma negatively affect the condition of the retina.

Redness of the eye

The first symptoms of lesions of the eye vessels are:

• redness of the protein membrane;
• the rapid development of fatigue while reading, prolonged work at the computer;
• a person does not see well at dusk;
• the field of view becomes smaller, the picture seems to blur;
• pressing pain in the temporal region;
• sunlight causes unpleasant sensations, "flies in front of the eyes" appear.

People who naturally have very good eyesight begin to fear the rapid development of symptoms of arterial hypertension. Today, there are various methods of treatment, which consist in surgical correction, therapy with vitamins and minerals. Before starting the fight against angiopathy of the eyes, it is worthwhile to achieve the normalization of blood pressure in the whole body.

The clinical picture of changes in the bottom of the blood in hypertension

The degree of vascular damage depends on the stage of the disease. At first, it may resemble overwork caused by excessive stress on the visual analyzer. As the symptoms progress, the symptoms intensify and do not disappear even after a good rest. People run to buy drops from conjunctivitis, wear protective glasses, try to avoid long-term work at the computer, not knowing the true nature of visual impairment. Unfortunately, many patients go to the doctor when the disease has already significantly affected the level of vision.

In the development of ocular hypertension, the following periods are distinguished:

• Retinal angiopathy arises from hypertension in the mild stage, which is accompanied by a short-term rise in blood pressure. Symptoms of the disease, such as headaches, "jumping midges" before the eyes, redness of the sclera, may disappear over time, and then reappear. A slight expansion of the veins, together with a spasm of the arteries, cause flushing of the fundus.
• Hypertensive angiosclerosis. Pathological changes in the eye vessels become organic. Compaction of the arterial walls joins the discomfort and redness, which leads to the "copper wire symptom" (the vessels of the fundus acquire a yellow-red color). Over time, it develops into the "silver wire symptom", characterized by a white tinge. At the intersection of the vessels, compression of the eye vein is observed, which causes the Salus-Hun symptom.
• Generalized retinopathy. Pathological changes from the vessels spread directly to the retina, causing its edema, the appearance of spots of white and yellowish color, figures in the form of a ring or a star are formed around the optic spot. At this stage of the disease, visual impairment is pronounced due to a decrease in its acuity.
• Involvement in the inflammatory process of the optic nerve - neuroretinopathy. His disc swells, from time to time there is swelling of the entire retina. The permeability of the vessels increases significantly, and their plasma dissection occurs.

At the last stage of development of ocular hypertension, an irreversible decrease in visual acuity occurs. Only timely treatment will help a patient with high blood pressure maintain the function of the visual analyzer and avoid dangerous complications.

With regular high blood pressure, target organs are affected: heart, brain, kidneys, fundus. The fundus of the eye in hypertensive disease (HD) can be in a different state or be unchanged. This is not an indicator of the stage of development of the disease, but simply a concomitant pathology that requires treatment. All changes that occur in the microvasculature of the body can be seen during ophthalmoscopy in the fundus.

Patients who gradually develop hypertension may not understand the cause of their symptoms and may not seek medical attention. But changes in vision are becoming a frequent reason for visits to the hospital and the initial detection of pathologies such as hypertension, diabetes mellitus.

Dangerous symptoms

Changes in the retinal vessels are manifested by such symptoms and complaints as:

• decreased visual acuity;
• violation of color perception;
• Pain in the eyes;
• "Flies" before the eyes, regardless of the time of day;
• narrowing of the field of view.

Severe changes in the fundus should be considered as a sign of the malignant course of hypertension.

Symptoms over time lead to optic atrophy or a number of complications associated with thrombosis or vascular obstruction, which is an ophthalmic emergency. The disease ends in blindness, both eyes are equally affected. An increased risk of progression of vascular pathology is observed in smokers, people leading a sedentary lifestyle, drinking alcohol and overweight.

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Classification of pathologies

Fundus changes in hypertension were recorded in 75 percent or more of patients. Ophthalmologists use terminology such as:

• Hypertensive angiopathy. Changes in vascular structures are temporary. They appear and disappear depending on the readings of the tonometer. The arteries are narrowed, and the veins are slightly dilated and form the "tulip" symptom. Redness of the nerve disc is observed.
• Angiosclerosis. A thickening of the arterial walls is added to the previous clinical picture, a change in their color to yellow-red, which is also called a symptom of copper wire. After blocking the blood flow in the artery, it becomes silvery in color, and the veins become more tortuous. Most often, the patient is worried about flies in the eyes, the stage is irreversible, but the progression may stop.

Hypertensive retinal angiopathy is inherent in the first phase of the course of hypertension - functional vascular disorders and unstable pressure

• Retinopathy. To the symptomatology is added damage to the retina, the appearance of hemorrhages on it and swelling. Plasmorrhages are observed along the nerve fibers, which resemble star figures. The disease is characterized by significant visual impairment.
• Neuroretinopathy is a disease with a poor prognostic sign. The optic disc swells, a large number of hemorrhages in the retina, which leads to a gradual atrophy of the nerve fibers.

There is an opinion that the stages of fundus pathology correspond to the stages of HD development. But this assumption is not true. The stages of the disease are in no way connected with each other and with each other. And neuroretinopathy can appear at IIA stage of GB.

Manifestations of GB at the bottom of the eye

The manifestations of arterial hypertension are varied, since various changes occur with the vascular structures. With a systemic increase in pressure, the arterioles become denser and narrower, and the veins dilate and become tortuous. The thickness of the arterioles increases, and the lumen of the veins increases and the wall weakens. Such metamorphoses are unevenly distributed and can be located within the same vessel.

Hypertensive angioretinopathy and neuroretinopathy - a further manifestation of the progression of the disease

With hypertension, atherosclerosis can be a concomitant disease, which affects the condition of the vascular walls and clogs the lumen with small plaques or lipid deposits. The symptomatology of atherosclerosis is a sign of "wire", which can acquire a copper or silver tint during ophthalmoscopy.

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A characteristic feature of the fundus in hypertensive disease is a sign of Salus Hun. It is detected as a strong reflection of light from the arteriole when the vein under the vessel is darkened. Gradually, the vein is pressed into the retina. In the clinic, the degree of development of this sign is determined. The symptom may appear in patients without hypertension in the older age group after 60 years.

The fundus vessels can be tortuous, if such a phenomenon is observed in the macular area, then the symptom is called Gvist. And the divergence of veins at an obtuse angle is called a symptom of "bull's horns" or "tulip". Sometimes the disease is accompanied by the appearance of dark spots with a red edging of Elching or Sigrist stripes. Signs appear due to a violation of microcirculation.

If there are bruises and exudates in the fundus, then in 65% of cases, patients have high blood pressure. Exudates can be hard or soft and often star-shaped. This condition develops due to the blockage of blood vessels with small blood clots and leakage of erythrocytes through the vascular wall.

Examination by an ophthalmologist with arterial hypertension is mandatory and includes visiometry, measurement of intraocular pressure

Diagnostic methods

The fundus of the eye in hypertension is examined by an ophthalmologist. Inspection device - direct or indirect ophthalmoscope. The procedure is quick and painless, it is accessible to patients. More accurate information about the state of the retina and fundus can be obtained on optical coherence tomography, which will cost more.

In many cases, these diseases signal to us about complex systemic diseases of our body as a whole. So, the narrowing of the vessels of the fundus will be the first alarming signal for all types of retinopathy, among which there will be secondary manifestations of diabetes mellitus, heart and vascular diseases and many others.

Other pathologies of the fundus will also tell about serious health problems, and their danger is the loss of visual acuity, which, most likely, cannot be restored. These diseases require urgent and immediate treatment.

Under the term “fundus”, doctors mean the inner part of the eyeball, which can be seen during ophthalmoscopy (this is such a non-invasive examination, it is performed by eye doctors using an ophthalmoscope in a dark room). During ophthalmoscopy, they can see eye diseases, as well as the first symptoms of many systemic diseases, without interfering with our body.

So, with the help of an ophthalmoscope, the doctor sees:

• The structure of the vessels of the eye, veins and arteries, their filling, possible narrowing or, conversely, expansion, the presence of hemorrhages.
• Optic nerve and macula, their defects.
• Retina, its thinning (dystrophy), detachment, tears.

We ourselves will not be able to see the fundus of the eye, but the doctor will tell a lot about our state of health simply by looking at the fundus through an ophthalmoscope.

Fundus pathology is always secondary. Therefore, it is imperative to look for the underlying disease.

Vascular diseases of the eye

Among diseases of the fundus, retinopathy (angiopathy) occupies the largest segment. It can be narrowing, inflammation of blood vessels, their thrombosis, too much blood filling or thinning, dystrophy. So, during vasoconstriction and thrombosis, the tissues of the eye will lack nutrients, and if they are overfilled, they become permeable and blood enters the retina, which causes its detachment and rupture.

There can be several reasons for retinopathy: diabetes mellitus, high blood pressure, rheumatoid arthritis or vascular atherosclerosis, age-related changes, congenital pathologies. The vessels of the eye are the first to react to pathogenic processes in the body, their changes are visible even when there are no other clinical manifestations yet.

Treatment of the choroid

Treatment will depend on the type of vascular changes. So, with thrombosis of the central vein or one of the branches, the veins expand and wriggle, retinal edema occurs, hemorrhages are small and larger. Symptoms include pain in the eye, a sharp deterioration in vision (most often in one eye), flashing lightning.

Thrombosis occurs as a result of heart disease, vascular atherosclerosis, varicose veins. Their treatment should take place in a hospital and involves thrombolis in the acute period, which includes the introduction of heparin behind the eyeball, treatment with fibronolytic drugs and anticoagulants; today, laser coagulation is often performed. After the removal of acute symptoms, treatment with anti-inflammatory eye drops and corticosteroids is carried out. It is not possible to significantly restore vision in such cases.

When the central retinal artery is occluded, its acute obstruction occurs. The reason for this may be blood clots, emboli, closure of the lumen; on examination, retinal edema, narrowing of the artery or its expansion are noted. The causes of this condition will be the same diseases as in venous thrombosis, narrowing of the lumen may occur due to hypertension, atrial fibrillation, and chronic infections. Usually it is impossible to establish the cause of the occlusion. Symptoms include a sharp decrease in vision, pain, pain in the eye, and the appearance of a veil.

Treatment should be started as early as possible. As part of it, thrombolis is performed, plasminogen or streptokinases are injected intravenously, the thrombus dissolves and blood circulation is restored. The forecasts for the restoration of vision are good. In the future, the patient is credited with vasodilators and diuretics, corticosteroids (to prevent occlusion in the future).

With vasculitis (angiopathies, periphlebitis, Eales disease), inflammation of the retinal vessels occurs, while as a result of damage to the vascular walls, they swell, edema appears, the blood supply to the tissues of the eye is disturbed, vasculitis can affect small areas or be extensive. The occurrence of vasculitis will be indicated by inflammation, edema and thickening of the vascular walls.

Symptoms of the disease will be poor vision, twilight blindness, dry eye syndrome. These diseases are most often affected by people aged 20–55 years, age-related vasculitis (retinopathy) affects the elderly. Treatment of vasculitis involves, first of all, the treatment of the underlying disease, as well as non-steroidal anti-inflammatory drops, sometimes glucocorticosteroids, complex eye preparations are good. This usually gives good results.

When this disease occurs, the main symptom will be a decrease (with subsequent loss) of visual acuity, which cannot be corrected. In this case, narrowing of the visual fields also occurs (the most difficult manifestation will be "tunnel" vision) and the appearance of cattle (blur, loss of areas, spots).

Atrophy of the optic nerve occurs as a result of a violation of its nutrition. There can be many reasons for this:

• genetic predisposition and hereditary diseases;
• disease of the structures of the eye, inflammation of the retina, compression of the optic nerve, its inflammation;
• tumors of the central nervous system, brain, abscesses;
• encephalitis and meningitis;
• poisoning, intoxication (including ethyl alcohol);
• severe hypertension;
• atherosclerosis;
• glaucoma.

With atrophy of the optic nerve, there is a partial death of fibers and their replacement with connective tissue cells. It is impossible to restore the lost nerve fibers, therefore, treatment will be aimed at preserving those that are in the process of destruction, stopping the atrophy process. Restoration of lost functions is impossible, optic atrophy is difficult to treat.

For the treatment of this disease, first of all, it is necessary to treat the underlying disease, in addition, eye drops (anti-inflammatory, corticosteroids), intravenous injections and into the structures of the eye will be prescribed, electrophoresis is indicated. All treatment will be aimed at improving metabolic processes in the nerve fibers of the optic nerve, tissues of the eye and the body as a whole, activating regenerative processes, as well as improving blood circulation in the optic nerve and its fibers, and at resolving pathological formations.

Retinal tumors

The most commonly diagnosed retinoblastoma is a retinal tumor, which is most often hereditary. The disease occurs in the prenatal period of fetal development, manifests itself at the age of 1-2 years. Luminescence of the eyes (white eye syndrome), a fixed pupil, and squint (appears a little later) are characteristic signs. But in many cases, only a regular examination of the fundus allows you to start treatment in a timely manner.

Choroidal melanoma will be next in frequency of detection. The tumor is located behind the retina in the choroid. It develops slowly and is asymptomatic for a long time. Deterioration of the general condition, decreased mobility of the eye, the inability to completely close it, edema of the eyelid and, in the later stages, bulging, occur quite late.

Treatment of fundus tumors involves surgery. Today, a laser is used to remove retinoblastoma. Cryotherapy and photocoagulation give good results in the early stages. In the later, enucleation or exenteration, radiation therapy, chemotherapy are used.

Melanoma treatment also involves the removal of the eyeball (exenteration), but very often the tumor is detected too late for its implementation (the presence of metastases to other organs and tissues).

Detachment, tears and degeneration of the retina

These fundus diseases are always secondary. Retinal detachments and retinal tears occur as a consequence of vascular retinopathy or vein thrombosis. Hemorrhage enters the retina and contributes to its edema, swelling and detachment from the choroid, with swelling, both single and multiple ruptures are possible.

Retinal thinning caused by genetic (congenital) factors or general diseases can contribute to the appearance of retinal tears.

In most cases, the causes of retinal dystrophy in childhood and young age are hereditary factors. Signs will be scotomas, loss of fields, violation (to a complete absence) of color perception.

In a more mature (after 50 years) and elderly - retinal dystrophy is caused by systemic diseases (high blood pressure, diabetes, etc.), as well as age-related changes in the body. In these cases, it is secondary.

Treatment of dystrophy is symptomatic, aimed at localizing the lesion. Drug treatment is indicated (firming, absorbable and corticosteroid injections, complex eye drops).

In case of retinal detachment and rupture, hospitalization is urgent. Symptoms appear quickly - this is a deterioration in visual acuity, lightning before the eyes, a veil, loss of fields. These pathologies can cause complete blindness. Vitreoretinal surgery (laser), cryotherapy, followed by conservative treatment are widely used here.

The forecasts for the restoration of vision are disappointing.

Prevention of fundus diseases

Diseases of the fundus are overwhelmingly secondary. They arise as a consequence of other systemic diseases of the body, which means that for their prevention it is important to timely and adequately treat the underlying disease.

For prevention, it is also important to have a correct lifestyle, moderate alcohol consumption, and quitting smoking. The eye is very sensitive to the intoxication of the body.

One of the important components of prevention will be a systematic examination of the fundus.

For adults, ophthalmoscopy is indicated once a year in the absence of eye diseases and at least once every six months if present. It is advisable for children and adolescents to undergo such a survey every six months.

This will allow timely identification of pathology (both secondary and due to hereditary factors) and initiate adequate treatment.

Get medical treatment and be healthy!