Causes, symptoms and treatment of retinal angiopathy
- Retinal angiopathy what is it?
- Causes of retinal angiopathy
- Retinal angiopathy symptoms
- Treatment of retinal angiopathy
Retinal angiopathy - what is it?
The retina needs a lot of nutrients and oxygen because it is responsible for capturing light waves, converting them into nerve impulses and transmitting them to the brain, where the image is formed. Insufficient blood supply to the choroid causes severe visual impairment. Angiopathy of the retinal vessels is not a separate disease, but a pathology that develops as a result of the destruction of blood vessel cells and dysfunction of their functions in diseases of various origins.
Retinal angiopathy is a pathological disorder of the tone of the blood vessels and fundus capillaries. As a result, their tortuosity, narrowing or expansion occurs. There is a change in the speed of blood flow and a failure of nervous regulation. Vascular defects make it possible to suspect and establish a diagnosis of the underlying disease before its clinical manifestations.
Pathology of this type signals the presence of a disease in the body that interferes with normal blood circulation, affects the tone of small and large vessels, causes necrotic lesions of a certain area of the retina, threatens complete or partial loss of vision or a decrease in its quality. Angiopathy is more common in adult patients (over 35 years old) against a background of chronic diseases, but sometimes it is diagnosed in childhood, and even in newborns.
Causes of retinal angiopathy
The most important structure of the eye - the retina - quickly reacts to the slightest disturbances in the blood supply system. Angiopathy is not an independent disease, it serves as a signal of a disease in which there is a negative effect on the eye vessels. Pathological processes in the body cause damage to the walls of the eye vessels, their modification and structural disruption.
The main reasons that lead to the occurrence of angiopathy:
- Hypertonic disease. High blood pressure has a detrimental effect on the walls of the eye vessels, destroying their inner layer. The vascular wall becomes denser and fibrosis occurs. There is a violation of blood circulation, the formation of blood clots and hemorrhages. Due to the constantly increased pressure, some vessels burst. A characteristic sign of hypertensive angiopathy is convoluted, narrowed vessels of the fundus. At the first degree of hypertension, changes are observed in the vessels of the eyes in a third of the patients, at the second degree - in half of the patients, and at the third stage of hypertension, the vessels of the fundus are modified in all patients;
Diabetes. The disease causes damage to the vascular walls not only in the retina of the eyes, but throughout the body. Pathology develops against a background of constantly elevated blood glucose levels. This causes the development of occlusions, seepage of blood into the retinal tissue, thickening and proliferation of the capillary wall, a decrease in the diameter of the vessels, and deterioration of microcirculation of blood in the eyes. Pathogenesis often leads to a gradual loss of vision;
- Injuries to the skull, eyes and spine (cervical spine), strong and prolonged compression of the chest. The condition leads to a sharp increase in intracranial pressure to high numbers, to rupture of the walls of blood vessels and hemorrhage in the retina;
- Hypotension. A decrease in vascular tone entails branching of blood vessels, their strong expansion, palpable pulsation, a decrease in blood flow velocity, and also promotes the formation of blood clots in the retinal vessels, increases the permeability of the vessel walls.
Factors that contribute to the occurrence of dangerous angiopathy:
- Increased intracranial pressure;
- Bad habits (smoking, alcohol);
- Poisoning (acute or chronic);
- Advanced age;
- Congenital anomalies of the walls of blood vessels;
There are several more varieties of this pathology, which are also sometimes found:
- Juvenile angiopathy. The inflammatory process in the retinal vessels develops for an unknown reason. It is accompanied by minor hemorrhages in the vitreous body of the eye and retina. The most severe type of the disease, which contributes to retinal detachment, also provokes cataracts and glaucoma, often leads to blindness;
- Angiopathy in premature infants. The disease is rare, the cause of its occurrence is a complication of childbirth or birth trauma. Retinal damage is characterized by proliferative changes in blood vessels, their narrowing and impaired blood flow;
Angiopathy during pregnancy. In the early stages, the disease does not carry threatening consequences, but when neglected it threatens with irreversible complications (retinal detachment). This pathology can develop in the second half of pregnancy against the background of hypertension or other diseases that are characterized by weakness of the vascular walls.
Any pathology or disease that negatively (directly or indirectly) affects the state of the vessels can lead to angiopathy.
The most common causes of angiopathy include:
- Arterial hypertension of various etiologies;
- Congenital pathologies of the vascular walls;
- Systemic vasculitis;
- Increased intracranial pressure;
- Traumatic eye damage;
- Head bruises;
- Certain blood disorders;
- Osteochondrosis of the cervical spine;
- Intoxication of the body.
Additional risk factors:
- Advanced age and presbyopia (senile vision);
- Work in hazardous production;
- Smoking and alcohol abuse;
- Exposure to radiation.
Retinal angiopathy symptoms
Vascular angiopathy is divided into types depending on the underlying disease:
- Diabetic angiopathy. Most common. In patients with type 1 diabetes, it is observed in 40% of cases, in patients with type 2 - in 20%. Usually, angiopathy begins to develop 7-10 years after the onset of the disease. There are two options for development: microangiopathy and macroangiopathy. With microangiopathy, capillaries are affected and thinned, which leads to impaired microcirculation and hemorrhages. With macroangiopathy, larger vessels are affected, occlusions (blockage) occur, which leads to retinal hypoxia;
- Hypertensive angiopathy. Against the background of chronically high blood pressure, retinal arteries narrow and veins expand. Gradually, vascular sclerosis forms, the venous bed becomes branched, exudates are formed due to blood seepage through the walls of the capillaries;
- Hypotonic angiopathy. Against the background of arterial hypotension, on the contrary, the arteries expand, the blood flow slows down, the pulsation of the veins is noted, the vessels become convoluted, which increases the likelihood of blood clots. The characteristic symptoms in this case are a throbbing sensation in the eyes and dizziness;
- Traumatic angiopathy. In case of head or chest injuries, squeezing of the abdomen, osteochondrosis, intraocular pressure can sharply increase. If the vessels do not withstand the load, then their ruptures occur with subsequent hemorrhages;
Angiopathy during pregnancy. In this case, angiopathy is functional and goes away on its own 2-3 months after delivery. This is explained by the fact that an increase in the volume of circulating blood causes a passive expansion of the retinal vessels. Another question is if diabetic or hypertensive angiopathy was present before pregnancy. In this case, it will most likely begin to progress rapidly.
The danger of angiopathy is that in the early stages and for quite a long time, it is asymptomatic. At the stage of a noticeable deterioration in vision, the process is usually already irreversible.
Common symptoms of angiopathy:
- Decreased visual acuity;
- The appearance of fog and spots before the eyes;
- Narrowing of the field of vision;
- A feeling of pulsation in the eyeball;
- The presence of burst blood vessels and yellow spots on the conjunctiva.
- Bleeding from the nose;
- Leg pain;
- Blood in the urine.
Treatment of retinal angiopathy
Treatment of angiopathy is carried out strictly individually for each patient, taking into account the nature of the disease and the severity. Drug therapy is aimed at completely eliminating the factors that provoke this pathology: in the case of hypertension, antihypertensive drugs are prescribed, in diabetes mellitus - drugs that help lower blood sugar levels. Treatment of angiopathy of the retinal vessels is carried out in a complex conservative and surgical manner with the interaction of many doctors: ophthalmologist, ophthalmologist, therapist, endocrinologist, cardiologist, rheumatologist, neuropathologist.
Therapy of the pathological process includes measures of a conservative nature:
- Taking drugs that improve blood microcirculation and strengthen vascular walls: Trental, Pentoxifylline, Actovegin, Vazonit, Solcoseryl, Arbiflex, Cavinton;
- Prescription of medications that reduce vascular permeability: Dobezilat, Parmidin, ginkgo biloba extract;
- Vitamin therapy with drugs of group B (B6, B1, B12, B15), C, P, E;
- Taking medications that prevent thrombosis: Trombonet, Lospirin, Dipyridamole, Magnikor, Ticlodipine;
- Drops to improve blood microcirculation in the eyes: Emoxipin, Taufon;
- Medicines for the treatment of a primary disease that provoked angiopathy of the retinal vessels (hypotensive, hypoglycemic);
- Physiotherapy procedures: laser irradiation, magnetic resonance therapy, acupuncture;
- Traditional medicine recommends taking herbal infusions: chamomile, St. John's wort, yarrow, lemon balm, hawthorn, bird knotweed.
If the treatment does not give the expected results, and the disease progresses, a surgical operation is prescribed to eliminate it. Methods of retinal laser coagulation, vitrectomy, photocoagulation are used. In advanced cases, the technique of treating angiopathy by purifying the blood with hemodialysis is used.
However, the possibilities of modern ophthalmic techniques do not guarantee the salvation of vision in angiopathy of the retinal vessels. Timely referral to a specialist, high-quality diagnosis of the disease, elimination of its root cause, constant and correct treatment of the underlying disease is the key to a favorable prognosis and complete recovery.
The author of the article: Degtyareva Marina Vitalievna, ophthalmologist, specially for the website ayzdorov.ru