Hypertensive Retinopathy

MD Ophthalmology Lectures

❖ Dr. Sumit Pandey, MD

❖ Lecturer, COMS
 HYPERTENSIVE
RETINOPATHY

❖ It refers to fundus changes occurring in patients

suffering from systemic hypertension.
 HYPERTENSIVE
RETINOPATHY

Pathogenesis
❖ Three factors which play role in the pathogenesis of
hypertensive retinopathy are vasoconstriction,
arteriosclerosis and increased vascular permeability.
 HYPERTENSIVE
RETINOPATHY

1. Vasoconstriction.
❖ Primary response of the retinal arterioles to raised blood
pressure is narrowing (vasoconstriction) and is related
to the severity of hypertension. It occurs in pure form in
young individuals, but is affected by the pre-existing
involutional sclerosis in older patients.
 HYPERTENSIVE
RETINOPATHY
2. Arteriosclerotic changes
❖ which manifest as changes in arteriolar reflex and A-V nipping
result from thickening of the vessel wall and are a reflection of
the duration of hypertension. In older patients arteriosclerotic
changes may preexist due to involutional sclerosis.

3. Increased vascular permeability

❖ results from hypoxia and is responsible for haemorrhages,
exudates and focal retinal oedema.
 HYPERTENSIVE
RETINOPATHY
Grading of hypertensive retinopathy
Keith and Wegner (1939) have classified hypertensive
retinopathy changes into following four grades:
❖ Grade I
❖ Grade II
❖ Grade III
❖ Grade IV
 HYPERTENSIVE
RETINOPATHY
• Grade I
❖ It consists of mild
❖ generalized arteriolar attenuation, particularly of
❖ small branches, with broadening of the arteriolar

• Grade II
❖ It comprises marked generalized narrowing and focal attenuation of
arterioles associated with deflection of veins at arteriovenous
crossings (Salus’ sign).
 HYPERTENSIVE
RETINOPATHY
• Grade III
❖ This consists of Grade II changes plus
❖ copper-wiring of arterioles
❖ banking of veins distal to arteriovenous crossings (Bonnet
sign)
❖ tapering of veins on either side of the crossings (Gunn sign).
❖ Flame-shaped haemorrhages, cotton-wool spots and hard
exudates are also present.
 HYPERTENSIVE
RETINOPATHY

• Grade IV
❖ This consists of all changes of Grade III plus silver-
wiring of arterioles and disc oedema.
Hypertensive retinopathy: A, grade I, B, grade II, C, grade III; D, grade IV.
 RETINOPATHY IN
PREGNANCY-INDUCED HYPERTENSION

❖ Pregnancy-induced hypertension (PIH), previously

known as ‘toxaemia of pregnancy’, is a disease of
unknown etiology characterised by raised blood
pressure, proteinuria and generalised oedema.
❖ Retinal changes are liable to occur in this condition
when blood pressure rises above 160/100 mm of Hg and
are marked when blood pressure rises above 200/130
mm of Hg.
 RETINOPATHY IN
PREGNANCY-INDUCED HYPERTENSION

❖ Earliest changes consist of narrowing of nasal arterioles,

followed by generalised narrowing. Severe persistent
spasm of vessels causes retinal hypoxia characterised by
appearance of ‘cotton wool spots’ and superficial
haemorrhages. If pregnancy is allowed to continue,
further progression of retinopathy occurs rapidly.
Retinal oedema and exudation is usually marked and
may be associated with ‘macular star’ or ‘flat macular
detachment’.
 RETINOPATHY IN
PREGNANCY-INDUCED HYPERTENSION

❖ Rarely it may be complicated by bilateral exudative

retinal detachment.
❖ Prognosis for retinal reattachment is good, as it resolves
spontaneously within a few days of termination of
pregnancy.
 RETINOPATHY IN
PREGNANCY-INDUCED HYPERTENSION

Management.
❖ Conservative treatment, the pregnancy may justifiably
be continued under close observation.
❖ However, the advent of hypoxic retinopathy (soft
exudates, retinal oedema and haemorrhages) should be
considered an indication for termination of pregnancy;
otherwise, permanent visual loss or even loss of life (of
both mother and foetus) may occur.
Thank you!
Have a wonderful day