HYPERTENSIVE RETINOPATHY 19 12 2017 Ayesha Abdullah Learning

HYPERTENSIVE RETINOPATHY 19. 12. 2017 Ayesha Abdullah

Learning outcomes 2 Describe the clinical presentation of hypertensive retinopathy (HR) Identify signs of HR on fundus photographs and correlate them with the underlying pathophysiological derangement List the ocular complications of Hypertension and correlate them with the underlying pathophysiological processes

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

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

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

6 Signs of Hypertensive Retinopathy

Arteriolar Narrowing- focal 7

8 Arteriolar Narrowing. Generalized

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AV crossing changes 11

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

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15 Cotton Wool Spots & macular star

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Disc Edema 17

Hypertensive Eye Disease 18 Hypertensive Choroidopathy (In young patients with acute hypertension. ) � Elschnig spots � Siegrist streaks Hypertensive Optic Neuropathy � Swelling Exudative Retinal Detachment Other ocular problems?

GRADING 19 Grade 1. Mild generalized retinal arteriolar narrowing Grade 2. 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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