1. Hypertensive retinopathy 19.12.2017
Ayesha Abdullah

2. 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

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

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

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

6. Signs of Hypertensive Retinopathy

7. Arteriolar Narrowing- focal

8. Arteriolar Narrowing- Generalized

11. 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

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

14. Venous changes

15. Cotton Wool Spots & macular star

17. Disc Edema

18. 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?

19. 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

21. ?