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High Pressure!

๐—›๐˜†๐—ฝ๐—ฒ๐—ฟ๐˜๐—ฒ๐—ป๐˜€๐—ถ๐˜ƒ๐—ฒ ๐—ฅ๐—ฒ๐˜๐—ถ๐—ป๐—ผ๐—ฝ๐—ฎ๐˜๐—ต๐˜†โฃ


The arteriosclerotic changes in HTN Retinopathy is due to chronically elevated blood pressure >140/90mmHgโฃ




1. ๐˜๐˜ข๐˜ด๐˜ฐ๐˜ค๐˜ฐ๐˜ฏ๐˜ด๐˜ต๐˜ณ๐˜ช๐˜ค๐˜ต๐˜ช๐˜ฐ๐˜ฏ โ†’ Vasospasm and increase in tone of retinal arteries โ†’ Generalised arterial narrowingโฃ

2. ๐˜š๐˜ค๐˜ญ๐˜ฆ๐˜ณ๐˜ฐ๐˜ต๐˜ช๐˜ค stage โ†’ Persistent elevation of BP โ†’ Intimal artery thickening, hyperplasia of media wall and hyaline degeneration โ†’ Severe generalised and focal areas of arterial narrowing, AV nicking, widening of central arteriolar light reflexโฃ

3. ๐˜Œ๐˜น๐˜ถ๐˜ฅ๐˜ข๐˜ต๐˜ช๐˜ท๐˜ฆ โ†’ Disruption of blood retinal barrier, necrosis of smooth muscles cells and endothelial cells โ†’ hemorrhages, hard exudates, cotton wool spotsโฃ

4. ๐˜”๐˜ข๐˜ญ๐˜ช๐˜จ๐˜ฏ๐˜ข๐˜ฏ๐˜ต ๐˜๐˜บ๐˜ฑ๐˜ฆ๐˜ณ๐˜ต๐˜ฆ๐˜ฏ๐˜ด๐˜ช๐˜ฐ๐˜ฏ/ ๐˜๐˜บ๐˜ฑ๐˜ฆ๐˜ณ๐˜ต๐˜ฆ๐˜ฏ๐˜ด๐˜ช๐˜ท๐˜ฆ ๐˜–๐˜ฑ๐˜ต๐˜ช๐˜ค ๐˜•๐˜ฆ๐˜ถ๐˜ณ๐˜ฐ๐˜ฑ๐˜ข๐˜ต๐˜ฉ๐˜บ โ†’ ICP elevated with effects on optic nerve โ†’ optic nerve ischemia, papilledema. Serous detachments can occur.โฃ

5. ๐˜๐˜บ๐˜ฑ๐˜ฆ๐˜ณ๐˜ต๐˜ฆ๐˜ฏ๐˜ด๐˜ช๐˜ท๐˜ฆ ๐˜Š๐˜ฉ๐˜ฐ๐˜ณ๐˜ฐ๐˜ช๐˜ฅ๐˜ฐ๐˜ฑ๐˜ข๐˜ต๐˜ฉ๐˜บ โ†’ Choroidal arteries โ†’ Fibrinoid necrosis โ†’ โ€‹Elschingโ€™s spotsโ€‹ (patches of RPE appearing yellow due to infarction of segments of choriocapillaries) โ†’ hyperpigmented with a margin of hypopigmentation as they resolve. Linear RPE Hyperplasia over infarcted choroidal arterioles โ†’โ€‹ Siegristโ€™s Streaksโฃ


Classifications - Shown on pictures โฃ


๐— ๐—ฎ๐—น๐—ถ๐—ด๐—ป๐—ฎ๐—ป๐˜ ๐—›๐˜†๐—ฝ๐—ฒ๐—ฟ๐˜๐—ฒ๐—ป๐˜€๐—ถ๐—ผ๐—ป/ Accelerated Hypertension is used to describe sudden increase in blood pressure >180/120mm Hgโฃ



โ— Papilledema - due to ischemia of axons(1)โฃ

โ— Constricted and tortuous retinal arterioles (5)โฃ

โ— Retinal hemorrhages especially flame shaped hemorrhages (2)โฃ

โ— Cotton wool spots (3)โฃ

โ— Hard exudates (4) (Macular star can be present)โฃ

โ— Retinal edemaโฃ

โ— Choroidopathy - fibrinoid necrosis of choroidal vesselsโฃ

โ— Macular serous retinal detachment - possible markerโฃ


Others related to Hypertension:โฃ

1. Anterior ischemic optic neuropathy (AION)โฃ

2. Retinal macroaneurysmsโฃ

3. Retinal vein occlusionsโฃ


๐— ๐—ฎ๐—ป๐—ฎ๐—ด๐—ฒ๐—บ๐—ฒ๐—ป๐˜โฃ

โ— Reduction of blood pressure with antihypertensive drugs is the mainstayโฃ

โ— Management of ischemic sequelae by PRP/Anti VEGFsโฃ

โ— Rule out secondary causes of malignant hypertensionโฃ

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