1. Hypertensive Retinopathy
Dr.Vijay

2. Definition What is Hypertensive Retinopathy?
Hypertensive retinopathy is retinal vascular damage caused by hypertension.

3. Pathophysiology Arteriosclerosis and atherosclerosis predominates
Systermic chronic hypertension
Arteriosclerosis and atherosclerosis predominates
Narrowing of retinal arterioles
Retinal Ischaemia
Hypoxia
Increased capillary permeability
Focal Retinal Oedema, retinal haemorrhage,cotton wool spots, hard exudates

5. Clinical Manifestation
Most patients are asymptomatic.
Some present with headaches and blurred vision.
On ophthalmoscopy :
Generalized arteriolar narrowing
Changes of the arterovenous crossings
 Flame haemorrhage
 Microaneurysms
 Exudates
 Arteriolar macroaneurysms
 Cotton-wool spots
Optic disc swelling
 FIPT ( Focal Intraretinal Periarteriolar Transudates)

7. 1. The cardinal funduscopic feature of malignant hypertension is disk swelling, which appears as blurring and elevation of disk margins. The top image also shows a characteristic star-shaped macular lesion caused by leaking retinal vessels; the bottom image also shows a characteristic flame-shaped hemorrhage and dilated veins.
2. Moderate hypertensive retinopathy is characterized by thinned, straight arteries; intraretinal hemorrhages; and yellow hard exudates (top). Cotton-wool spots (bottom) are an additional feature of moderate hypertensive retinopathy. They are caused by focal axonal swelling of the retinal nerve fiber layer as a result of small-vessel occlusion.

8. Retinal arteriolar narrowing due to thickening and opacification of arteriolar walls (copper wiring) caused by hypertensive arteriosclerosis. Image also shows macular edema.

9. Classification Keith-Wagener-Barker classification Grade Description
Slight narrowing, sclerosis, and tortuosity of the retinal arterioles; mild, asymptomatic hypertension
Grade 2
Definite narrowing, focal constriction, sclerosis, and AV nicking; blood pressure is higher and sustained; few, if any, symptoms referable to blood pressure
Grade 3
Retinopathy (cotton-wool patches, arteriolosclerosis, hemorrhages); blood pressure is higher and more sustained; headaches, vertigo, and nervousness; mild impairment of cardiac, cerebral, and renal function
Grade 4
Neuroretinal edema, including papilledema; Siegrist streaks, Elschnig spots; blood pressure persistently elevated; headaches, asthenia, loss of weight, dyspnea, and visual disturbances; impairment of cardiac, cerebral, and renal function

11. Diagnosis
Diagnosis is made by thorough history of the patient, ophthalmoscopy (direct or indirect) and also physical examination.
History
May reveal decrease of patient vision, occipital headache and high blood pressure.
 Physical examination
May detect elevation of blood pressure
Ophthalmoscopy
Show changes in arteriovenous crossings
Cotton-wool spot
Flame haemorrhage
Silver wire appearance of narrowed arterioles
Nicking of veins where arteries cross them (arteriovenous nicking)
Hard exudates “lipids deposites”
“Macular star”
Flame shape haemorrhage
Retinal oedema
Swelling of the optic nerve
Aterial microaneurysms
Arteriolar macroaneurysms  

12. Differential Diagnosis
Diabetic retinopathy
Collagen vascular diseases

13. Management
A major aim of treatment is to prevent, limit, or reverse such target organ damage by lowering the patient's high blood pressure.
Lifestyle changes  Promote Healthy lifestyle; exercise, healthy foods
Advice patient to reduce the Blood Pressure
Taking the medication accordingly
Referral to medical team

14. Complications of hypertensive retinopathy include:
Blindness
Reduce in vision