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  • Ophthalmology: retina angiopathy

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    In ophthalmology, as in no other branch of medicine, there is a significant layer of diseases not related to the eyes, but manifested precisely by their pathology. No exception is retinal angiopathy.

    Brief anatomy and physiology of the eyes

    Eyes are paired organs located in special depressions of the skull bones - the eye sockets. Outwardly it is a small rounded form of education. Their anterior margin looks more convex due to protrusion of the cornea. The anterior chamber of the eye. The larger part of the body occupies the vitreous body. It is covered externally by a dense network of blood vessels. This is the so-called choroid of the eyes.

    The main function of the eyes is the perception of light photons and their projection in the form of pulses. These pulses in the cerebral cortex form a visual image. The perception of photons of light is carried out due to the retina of the eye - a dense set of nerve cells located on its inner side in the region of the vitreous. The retina is absent only in the anterior part of the eye.

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    All the functioning of the eye is directly dependent on the condition of the choroid.

    Definition of the concept of angiopathy

    This is important! The concept of angiopathy of the retina implies any disturbance of its vascular membrane. More correctly, it refers directly to the vessels and lies in their pathological spasm, dystonia. As a result, there is a disruption in the functioning of the eye.

    The retina is the first to suffer because of the high degree of metabolism of its cells. Therefore, they are highly sensitive to the change in trophism that the vessels provide. This manifests itself in the form of a weakening of vision. Its clarity and color perception falls. But the degree of suddenness of the disorders and their severity directly depend on the causes, which result in angiopathy of the retina.

    Causes and Classification of Angiopathies

    All causes that cause damage to the choroid of the eyes are classified according to several criteria.

    • The immediate cause of the onset of pathology.
    • Degree of angiopathy. He talks about the depth of the pathological process.

    For the reason leading to the appearance of angiopathy, all the pathologies of the choroid are divided into the following groups:

    1. Non-traumatic angiopathy. It is associated with various pathological processes both in the eye itself and in the body. The last option is most often observed.
      • Eye pathology. They are inflammatory and non-inflammatory diseases. Inflammatory nosologies include inflammation around the eyeball. Vascular lesions can rarely be noted. Significantly more noninflammatory diseases are. Such as myopia and hypermetropia. Both belong to the violation of refraction and accommodation. This disrupts normal vision. As a result, the cross, entering the ray, is obtained before or behind the retina. To correct it, the muscles of the eyeball try to straighten the position by changing the shape of the eyeball. This inevitably leads to a significant displacement of the retina and the choroid. Of course, the vessels have a certain degree of plasticity. But it is not infinite. Most often angiopathy of the vessels of the fundus is observed with myopia-myopia.
      • Pathologists of the whole body. They have nothing to do with the eyes, but always lead to the pathology of their vascular membrane. Among them, hypertension and diabetes mellitus are at the first place in the risk of angiopathy of the retina. That is why such patients are regularly inspected eye fundus, whose angiopathy is clearly visible. Also often angiopathy occurs with systemic vasculitis and some autoimmune diseases.
      • Harmful habits. Smoking is one of the main causes of angiopathy of the retina, not caused by the disease. Associated with the harmful effects of nicotine on the vascular tone.
      • Mixed angiopathy. Combines the signs of both inflammatory and non-inflammatory pathologies. A classic example is Illza disease. With it there is a hemorrhage, a local vascular spasm and vasculitis or inflammation of the vessels. Often, this type of angiopathy is called youthful because it is characteristic of young people.
    2. Traumatic pathology of the vessels of the eye. It is observed as a result of external exposure to the eye or skull. Symptoms that characterize traumatic angiopathy of the retina: the fact of injury, a sudden onset and more often a one-sided lesion. Here the main active factor is the traumatic effect on the vessels. With a direct eye injury( eyeball contusion), a shock wave or displacement of the vitreous can lead to overstretching and even rupture of the vessels. The general craniocerebral injury mainly leads to the development of pathological spasms of the vessels and their dystonia due to the pressure of the intracranial fluid.

    Diagnosis of the disease

    Clinical methods for identifying characteristic complaints can not be reliable signs. Since they can be observed in diseases of the retina itself.

    In connection with what has long been used examination of the fundus. And here we distinguish several degrees of angiopathy, which depend on the state of the vessels of the fundus.

    1. Angiopatia I degree is characterized by minimal changes on the fundus. There is an expansion of veins and narrowing of the arteries. Increases the tortuosity of blood vessels.
    2. Angiopathy of the 2nd degree has several distinctive patterns in various pathological conditions. In the case of diabetic ophthalmopathy, a large crimp of the vessels is observed with the appearance of a large number of aneurysms. The stages of vascular dystonia along the Salus-Gunn do not have a clear gradation as in hypertensive angiopathy. In arterial hypertension, stage 2 is divided into two subcategories. Since here the mechanism of angiopathy is directly related to the vessels, and not to their innervation( this is the case with diabetes mellitus).In addition, most ophthalmologists tend to consider Salus-Gun symptoms as signs of arteriosclerosis of the vessels, which is characteristic of hypertension.
      • Salus-Gunn-1 or angiopathy IIa. Narrowing the lumen of the arteries leads to a decrease in the red spectrum of reflection. They are visible as red-brown strands. Sometimes the vessels are called "copper wire".
      • Salus-Gunn-2 or angiopathy IIb. A further narrowing of the arteries makes them look like "silver threads" - the reflection occurs only from the walls of the vessels, and the red spectrum no longer exists.
    3. III degree of angiopathy. Changes in the fundus: swelling of the optic nerve and hemorrhagic impregnation of the retina. For hypertension, the onset of grade 3 is characterized by the Salus-Gunn-3 symptom. The retina seems torn.

    Principles of treatment of

    In the treatment of angiopathy of the eye, an immediate cause is important. Since the first stages are well suited to reverse development in the event of its elimination. Of course, the age of the patient plays an important role.

    In the first place of conservative treatment, in addition to etiotropic drugs and methods( ie, aimed at the immediate cause) is the mode of work and rest, as well as compliance with the diet. Among drugs, a good effect is given by vascular medications( angioprotectors, disaggregants), calcium preparations.

    Surgical methods are used in the case of late stages, the presence of complications( multiple hemorrhages and detachment of the retina).Can use both surgical intervention and indirect exposure to the laser. But this requires very strict testimony, which exposes the attending physician in conjunction with the ophthalmologist.

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