Eye is the only organ in the human body where blood vessels of all calibres can be seen clearly. Right from arteries to capillary network to veins. This provides a unique opportunity to an eye specialist to evaluate changes in the blood vessels and convey their implications to other specialist. Cardiologists, Obstetricians and Internal Medicine specialists especially seek such information from their ophthalmic colleagues.
A patient with hypertension should be seen by an ophthalmologist to record changes in the blood vessels of retina as well as the retinal grounds. This information is shared with the treating doctor who selects appropriate medicines and adjusts their dose. At times an ophthalmologist suspects hypertension and sends the patient to an internist for evaluation. Hypertensive Retinopathy is an important indicator of life prognosis as well as adequacy of control of blood pressure.
- Spasm of blood vessels (angiospasm). Excessive spasm in the vessels indicates inadequate control
- Reactive Sclerosis. Blood vessel walls thicken and make their walls opaque. This indicates a chronically raised blood pressure. Vessel walls turn copper to silver hue in due course if the pressure is not controlled. Some sclerosis comes with age as well- arteriosclerosis, which an experienced ophthalmologist can differentiate from reactive sclerosis.
- Hard Exudates. These are residual deposits of fat and protein that leak out of blood vessels when the pressure is very high. They can at times cause irreversible damage to the retina leading to poor vision.
- Soft Exudates. These represent areas of infarction in the superficial retinal layers implying a lack of oxygen supply to an area.
- Haemorrhages. They can be different in shape and present at different depths in the retina. Flame shaped superficial haemorrhages are typically seen in hypertensive retinopathy.
- Papilloedema. This is a serious condition in which swelling in the brain occurs an dis picked up during eye examination. Patient should be hospitalised immediately when such an observation is made.
Needless to say a detailed examination of eyes is an integral part of "hypertension management" as it gives important information to an internist. Adequacy of BP control, t iteration of dose, speed with which pressure is to be brought down as well as selection of drugs are guided by the ophthalmic examination.
An eye surgeon is an important stake holder in hypertension management and regular exchange of clinical information with treating doctors enhances quality of life and longevity of a patient.