The eye in general vascular disease hypertension and arteriosclerosis

Abstract

Cases of hypertensive disease may be recognized and classified by the fundus appearances into two main groups: (1) Those associated with retinal evidence of senile or premature involutionary sclerosis; (2) Those without such features. In the first group, hypertension occurs in vessels already largely defended by involutionary sclerosis. The fibrotic portions of the vessels become dilated with increased pressure, while vasoconstriction is limited to peripheral portions and smaller branches. This picture is associated with true benign hypertension. In the second group, early cases show arteriolar hypertonus in the retina. A few cases present with advanced retinopathy of malignant type, the vessels having the features of hyperplastic change and hypertonus. Many other cases, however, present a fundus picture in which fibrosis, hyperplasia, and hypertonus are found in different portions of the same retinal artery and its branches. Although these latter cases develop more rapidly than the elderly involutionary type, they do not run the course of malignant hypertension; the fundus appearances are associated with a severe degree of benign hypertension and the arteriosclerosis is of a reactive or secondary type. The ophthalmoscopic classification is supported by evidence adduced from statistical and histological studies, providing a method of recording the ocular appearances directly in terms of general pathology.