High Pressure!


𝗛𝘆𝗽𝗲𝗿𝘁𝗲𝗻𝘀𝗶𝘃𝗲 𝗥𝗲𝘁𝗶𝗻𝗼𝗽𝗮𝘁𝗵𝘆⁣

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The arteriosclerotic changes in HTN Retinopathy is due to chronically elevated blood pressure >140/90mmHg⁣

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𝗦𝘁𝗮𝗴𝗲𝘀:⁣

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1. 𝘝𝘢𝘴𝘰𝘤𝘰𝘯𝘴𝘵𝘳𝘪𝘤𝘵𝘪𝘰𝘯 → Vasospasm and increase in tone of retinal arteries → Generalised arterial narrowing⁣

2. 𝘚𝘤𝘭𝘦𝘳𝘰𝘵𝘪𝘤 stage → Persistent elevation of BP → Intimal artery thickening, hyperplasia of media wall and hyaline degeneration → Severe generalised and focal areas of arterial narrowing, AV nicking, widening of central arteriolar light reflex⁣

3. 𝘌𝘹𝘶𝘥𝘢𝘵𝘪𝘷𝘦 → Disruption of blood retinal barrier, necrosis of smooth muscles cells and endothelial cells → hemorrhages, hard exudates, cotton wool spots⁣

4. 𝘔𝘢𝘭𝘪𝘨𝘯𝘢𝘯𝘵 𝘏𝘺𝘱𝘦𝘳𝘵𝘦𝘯𝘴𝘪𝘰𝘯/ 𝘏𝘺𝘱𝘦𝘳𝘵𝘦𝘯𝘴𝘪𝘷𝘦 𝘖𝘱𝘵𝘪𝘤 𝘕𝘦𝘶𝘳𝘰𝘱𝘢𝘵𝘩𝘺 → ICP elevated with effects on optic nerve → optic nerve ischemia, papilledema. Serous detachments can occur.⁣

5. 𝘏𝘺𝘱𝘦𝘳𝘵𝘦𝘯𝘴𝘪𝘷𝘦 𝘊𝘩𝘰𝘳𝘰𝘪𝘥𝘰𝘱𝘢𝘵𝘩𝘺 → Choroidal arteries → Fibrinoid necrosis → ​Elsching’s spots​ (patches of RPE appearing yellow due to infarction of segments of choriocapillaries) → hyperpigmented with a margin of hypopigmentation as they resolve. Linear RPE Hyperplasia over infarcted choroidal arterioles →​ Siegrist’s Streaks⁣

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Classifications - Shown on pictures ⁣

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𝗠𝗮𝗹𝗶𝗴𝗻𝗮𝗻𝘁 𝗛𝘆𝗽𝗲𝗿𝘁𝗲𝗻𝘀𝗶𝗼𝗻/ Accelerated Hypertension is used to describe sudden increase in blood pressure >180/120mm Hg⁣

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𝗦𝗶𝗴𝗻𝘀:⁣

● Papilledema - due to ischemia of axons(1)⁣

● Constricted and tortuous retinal arterioles (5)⁣

● Retinal hemorrhages especially flame shaped hemorrhages (2)⁣

● Cotton wool spots (3)⁣

● Hard exudates (4) (Macular star can be present)⁣

● Retinal edema⁣

● Choroidopathy - fibrinoid necrosis of choroidal vessels⁣

● Macular serous retinal detachment - possible marker⁣

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Others related to Hypertension:⁣

1. Anterior ischemic optic neuropathy (AION)⁣

2. Retinal macroaneurysms⁣

3. Retinal vein occlusions⁣

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𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁⁣

● Reduction of blood pressure with antihypertensive drugs is the mainstay⁣

● Management of ischemic sequelae by PRP/Anti VEGFs⁣

● Rule out secondary causes of malignant hypertension⁣


Image from Rajan Eye Care Hospital #ophthalmology #ophthal #doctor #health #medical #vision #education #optometry #medicalstudent #optometrist #medicine #eye #ophtho #ophthalmologist #ophthalmo #med #medicaleducation #ophthalmologyresident #ophthalmologyresidency #hypertension #hypertensiveretinopathy #malginanthypertension #retina #papilledema #discedema #cottonwoolspots #hardexudates



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