HYPERTENSIVE RETINOPATHY

DR. AMBER
SYSTEMIC HYPERTENSION
 Diagnosed on blood pressure recording
on several consecutive occasions of
140/90 mm of Hg or more.

 PRESENTATION:
 Usually 5th to 6th decade
 CAUSES:
 95% Idiopathic/essential
 5% - secondary
 renal disease
 Pheochromocytoma

 Pregnancy (eclampsia, pre-eclampsia)

 Drugs (steroids, sympathomimetics, NSAIDS)

 Ocular effects of hypertension
 Posterior segment changes
 Retina
 Choroid
 Optic nerve
 Retinal changes
 Primary response is vasoconstriction in retinal arterioles.
 Sustained hypertension (disruption of blood retinal
barrier)
 Fundus:
 Arterial narrowing
 Focal or generalized
 Severe hypertension –

 cotton wool spots

 Vascular leakage
 Flame shaped retinal hemorrhages
 retinal edema

 Chronic-macular star configuration

 Arteriolosclerosis
 Thickening of vessel
wall
 Most important
clinical sign-
changes in
arteriovenous
crossing( AV
nipping)
 Grading of arteriosclerosis
 Grade-1:
 Subtle broadening of arteriolar light reflex
 Mild arteriolar attenuation especially small

branches
 Grade II:
 Obvious broadening of arteriolar light reflex
 Deflection of veins at AV crossing (Salus sign)
 Grade III:
 Copper wiring of arterioles
 Bonnet sign (banking of veins)
 Gunn sign (tapering of veins)
 Right angle deflection of veins
 Grade IV:
 Silver wiring of
arterioles
 Plus grade III
changes
 Modified Scheie classification
 Grade 0: no change
 Grade 1: barely detectable arterial
narrowing
 Grade 2: obvious narrowing with focal
irregularities
 Grade 3: grade 2 plus retinal hemorrhages
and/or exudates
 Grade 4: grade 3 plus disc swelling
 HYPERTENSIVE CHOROIDOPATHY
 Rare
 Young patients of acute hypertensive
crises
 Elschnig spot- represent focal choroidal
infarcts
 Siegrist streaks- represent fibrinoid
necrosis
 Exudative retinal detachment
 Hypertensive optic neuropathy
 Variable presentation
 Linear flame shaped hemorrhages at the
margins of disc
 Blurring of disc margins

 Florid disc edema

 Congestion of associated retinal veins

 Ocularassociations and complications
of hypertension
 Retinal vein occlusion
 Retinal artery occlusion

 Anterior ischemic optic neuropathy

 Oculomotor nerve palsy

 Adversely affect pre-existing diabetic

retinopathy