1. HYPERTENSIVE RETINOPATHY
Dr. Shinisha Paul

2. introduction
Ophthalmic findings of end organ damage secondary to systemic hypertension
affects precapillary arterioles and capillaries
Uncontrolled systemic hypertension leads to nonperfusion at various retinal levels and to neuronal loss

3. Retinal blood supply Retinal blood vessels and choroidal blood vessels
Ophthalmic artery central retinal artery
posterior ciliary arteries
long posterior ciliary Short posterior ciliary
Anterior choriocapillaries Posterior choriocapillaries

5. Outer layers are avascular – diffusion from the choriocapillaries
Central retinal artery – end artery
Retinal veins are in inner retina and interdigitate with veins
Artery lies anterior to vein (common adventitial coat)

8. Pathophysiology Arteriosclerosis – breakdown in autoregulation
High pressure in arterioles transmitted to capillaries
Capillary closure or hemorrhage

10. Clinical features Asymptomatic Headache Blurred vision
Transient vision loss

11. Changes in hypertensive retinopathy
Focal arteriolar narrowing and arterial venous nicking – sclerosis
Flame hemorrhages
blot hemorrhages
Microaneurysm
hard exudates
Cotton wool spots
Optic disc swelling

17. AV crossing changes: Venous deflection – salus sign
Venous nipping – gunn sign
Distal banking – bonnet sign

22. Classification Keith Wagner and Barker
Grade 1 - Mild to moderate narrowing
Grade 2 - a. There is moderate to marked narrowing of retinal arterioles.
b. Copper wire reflex
c. Typical arteriovenous crossing changes
Grade 3 – a. retinal arteriolar narrowing and focal constriction.
b. Silver wire appearance
c. Retinal oedema
d. Cotton wool or soft exudates
e. Superficial flame-shaped haemorrhages

23. Grade 4 : grade 3 and macular star with papilledema

24. Modified Scheie Classification of "Hypertensive Retinopathy":
Grade No changes
Grade 1 - Barely detectable arterial narrowing
Grade 2 - Obvious arterial narrowing with focal irregularities
Grade 3 - Grade 2 plus retinal hemorrhages and/orexudates
Grade Grade 3 plus disc swelling

27. Hypertensive Choroidopathy
2018/2/5
Typically occurs in young patients
episode of acute hypertension associated with preeclampsia, eclampsia, pheochromocytoma, or renal hypertension
Elschnig spots - non perfused choriocapillaries
Siegrist streaks - hyperpigmented streaks

28. 2018/2/5

29. 2018/2/5

30. Pregnancy induced hypertension
2018/2/5
Hypertension in pregnant women after 20 weeks of gestation
Symptoms : Rapid or sudden weight gain, high blood pressure, protein in the urine, and swelling in the hands, feet, and face
Blurry vision, spots before your eyes that don’t resolve.
Related to vascular endothelial dysfunction
Exudative retinal detachment - choroidal ischemia

31. Risk factors for PIH Is under age 20 or over age 35
2018/2/5
Is under age 20 or over age 35
Has a history of chronic hypertension
Has a previous history of PIH
Has a female relative with a history of PIH
Is underweight or overweight
Has diabetes before becoming pregnant
Has an immune system disorder, such as lupus or rheumatoid arthritis
Has kidney disease
Has a history of alcohol, drug, or tobacco use
Is expecting twins or triplets

32. Treatment Grade 1-3 : control of hypertension
Grade 4 : immediate intervention
(Malignant hypertension)
PIH : regular fundus examination

33. Thank you