Hypertensive retinopathy 19.12.2017 http://www.eophtha.com/eophtha/ppt/Hypertensive%20retinopathy.html Ayesha Abdullah

Learning outcomes Describe the clinical presentation of hypertensive retinopathy (HR) Identify signs of HR on fundus photographs and correlate them with the underlying patho- physiological derangement List the ocular complications of Hypertension and correlate them with the underlying patho- physiological processes

Pathogenesis Vasoconstriction- Arterial narrowing and closure Cotton Wool Spots Vascular leakage Flame-shaped Hemorrhages Retinal edema Hard exudates Arteriosclerosis AV nipping Choroidal changes-Infarcts

Symptoms 1. Gradual vision loss 2. Sudden loss of vision Usually silent

Signs of hypertensive retinopathy Arterial narrowing Vascular leakage Cotton wool spots Arteriosclerosis

Signs of Hypertensive Retinopathy

Arteriolar Narrowing- focal

Arteriolar Narrowing- Generalized

AV crossing changes Deflection of veins at AV crossings—Salus sign Banking of veins distal to AV crossings ---Bonnet Sign Tapering of veins on both sides of the AV crossings--Gunn Sign

Vascular Leakage Flame shaped haemorrahges Exudates Macular star Swelling of the optic disc

Venous changes

Cotton Wool Spots & macular star

Disc Edema

Hypertensive Eye Disease Hypertensive Choroidopathy (In young patients with acute hypertension.) Elschnig spots Siegrist streaks Hypertensive Optic Neuropathy Swelling Exudative Retinal Detachment Other ocular problems?

GRADING Grade 1. Mild generalized retinal arteriolar narrowing Focal arteriolar narrowing and arteriovenous nipping ‘copper wiring’ opacified appearance of arteriolar walls may be seen. • Grade 3. Grade 2 plus retinal haemorrhages (dot, blot, flame), exudates (chronic retinal oedema may result in the deposition of hard exudates around the fovea as a ‘macular star’ and cotton wool spots. • Grade 4. Severe grade 3 plus optic disc swelling

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