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Hypertensive retinopathy
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Hypertensive retinopathy

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Power point presentation by me a med student on hypertensive retinopathy. i hope it does help a lot of people =)

Power point presentation by me a med student on hypertensive retinopathy. i hope it does help a lot of people =)

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  • 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; intraretinalhemorrhages; 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.
  • Retinal arteriolar narrowing due to thickening and opacification of arteriolar walls (copper wiring) caused by hypertensive arteriosclerosis. Image also shows macular edema.
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    • 1. Hypertensive Retinopathy Nabilah Ayob 060100814 Group H4
    • 2. Definition• What is Hypertensive Retinopathy?• Hypertensive retinopathy is retinal vascular damage caused by hypertension.
    • 3. Pathophysiology Arteriosclerosis Systermic and Narrowing of chronic atherosclerosis retinal arterioleshypertension predominates Increased Retinal Hypoxia capillary Ischaemia permeability Focal Retinal Oedema, retinalhaemorrhage,cotton wool spots, hard exudates
    • 4. 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)
    • 5. Classification• Keith-Wagener-Barker classification Grade Description Grade 1 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
    • 6. • Scheie classification Staging under this system is as follows: Stage 0 - Diagnosis of hypertension but no visible retinal abnormalities Stage 1 - Diffuse arteriolar narrowing; no focal constriction Stage 2 - More pronounced arteriolar narrowing with focal constriction Stage 3 - Focal and diffuse narrowing, with retinal hemorrhage Stage 4 - Retinal edema, hard exudates, optic disc edema The Scheie classification also grades the light reflex changes from arteriolosclerotic changes, as follows : Grade 0 - Normal Grade 1 - Broadening of light reflex with minimal arteriolovenous compression Grade 2 - Light reflex changes and crossing changes more prominent Grade 3 - Copper-wire appearance; more prominent arteriolovenous compression Grade 4 - Silver-wire appearance; severe arteriolovenous crossing changes
    • 7. Modified Scheie classificationGrade 0 - No changesGrade 1 - Barely detectable arterial narrowingGrade 2 - Obvious arterial narrowing with focal irregularitiesGrade 3 - Grade 2 plus retinal hemorrhages and/or exudatesGrade 4 - Grade 3 plus disc swelling
    • 8. Diagnosis• Diagnosis is made by • Ophthalmoscopy thorough history of the – Show changes in patient, ophthalmoscopy arteriovenous crossings (direct or indirect) and also – Cotton-wool spot physical examination. – Flame haemorrhage• History – Silver wire appearance of narrowed arterioles – May reveal decrease of patient vision, occipital – Nicking of veins where headache and high blood arteries cross them pressure. (arteriovenous nicking)• Physical examination – Hard exudates “lipids deposites” – May detect elevation of blood – “Macular star” pressure – Flame shape haemorrhage – Retinal oedema – Swelling of the optic nerve – Aterial microaneurysms – Arteriolar macroaneurysms
    • 9. Differential Diagnosis • Diabetic retinopathy• Collagen vascular diseases
    • 10. Management• A major aim of treatment is to prevent, limit, or reverse such target organ damage by lowering the patients 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
    • 11. Complications• Complications of hypertensive retinopathy include: • Blindness • Reduce in vision