𝗛𝘆𝗽𝗲𝗿𝘁𝗲𝗻𝘀𝗶𝘃𝗲 𝗥𝗲𝘁𝗶𝗻𝗼𝗽𝗮𝘁𝗵𝘆
The arteriosclerotic changes in HTN Retinopathy is due to chronically elevated blood pressure >140/90mmHg
𝗦𝘁𝗮𝗴𝗲𝘀:
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
Classifications - Shown in pictures
𝗠𝗮𝗹𝗶𝗴𝗻𝗮𝗻𝘁 𝗛𝘆𝗽𝗲𝗿𝘁𝗲𝗻𝘀𝗶𝗼𝗻/ Accelerated Hypertension is used to describe sudden increase in blood pressure >180/120mm Hg
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
Others related to Hypertension:
1. Anterior ischemic optic neuropathy (AION)
2. Retinal macroaneurysms
3. Retinal vein occlusions
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
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