THIS PRESENTATION COVERS ALL ASPECTS OF HTN RETINOPATHY - EPIDEMIOLOGY , PATHOPHYSIOLOGY , CLINICAL FEATURES AND TREATMENT

1. HYPERTENSIVE
RETINOPATHY
DR ARNAV SAROYA

5. 1. Genetic factors can also play a role with certain genotypes
associated with an increased risk of hypertensive retinopathy.
2. Smoking is considered to have a strong association with severe or
malignant hypertensive retinopathy .
3. Renal dysfunction (persistent microalbuminuria and low creatinine
clearance) in patients has shown to be a marker for hypertensive
retinopathy and end-organ damage.
4. Arteriosclerotic changes of hypertensive retinopathy are
caused by chronically elevated blood pressure, defined as
systolic greater than 140 mmHg and diastolic greater than 90
mmHg. Hypertension is usually essential and not secondary to
another disease process.
ETIOLOGY

6. •Retinal blood vessels have distinct features, which
differentiate them from other blood vessels
• The absence of sympathetic nerve supply
• Autoregulation of blood flow
• Presence of blood-retinal barrier
•Thus, an increase in blood pressure (BP) is transferred
directly to the vessels which initially constrict.
• However, a further increase in BP overcomes this
compensatory tone and damage to the muscle layer and
endothelium ensues.

18. Bonnet’s sign: Banking of the retinal vein distal to
the AV crossing

19. Decrease in the arteriovenous ratio to 1:3 ( the normal
ratio is 2:3).

34. Collaterals.

44. •Siegrist's streak: RPE hyperplasia over choroidal infarcts

65. COMPLICATIONS
• Retinal artery occlusion
• Retinal vein occlusion
• Macro aneurysm of retinal arteriole
• Diabetic retinopathy (DR): Both hypertensive retinopathy and
DR together in a patient is called as mixed retinopathy. HTN is
also known to be a major risk factor for the progression of DR.
• Anterior ischemic optic neuropathy
• Age-related macular degeneration
• Glaucoma
• Retinal arteriolar emboli
• Epiretinal membrane formation
• Cystoid macular edema

66. MANAGEMENT
• Systemic hypertension should be controlled as a primary
measure for Hypertensive retinopathy.
• Change in lifestyle with reduction of general risk factors (salt
restriction, avoidance of tobacco) help in controlling
hypertension.
• Drugs may be used from groups like:
• – Diuretics.
• – Beta blockers.
• – Angiotensin converting enzyme inhibitors.
• – Calcium channel blockers.
• – Angiotensin receptor antagonists.

67. •Patients with severe hypertensive retinopathy are at
increased risk of coronary artery disease, stroke or
peripheral vascular disease. Arteriosclerotic
changes increases the risk of retinal
macroaneurysms, retinal artery or vein occlusion.
Visual acuity may be reduced due to involvement of
optic nerve and macula.
•Hypertensive retinopathy with vision threatening
complication: Vision threatening complications like
retinal oedema may be treated with laser therapy or
intravitreal injection of vascular endothelial growth
factor (VEGF) drugs.