This PPT is beneficial for undergraduate Medical students

1. Dr. Atul Kumar Anand
Senior Resident
AIIMS Patna

2.  incidence of Hypertensive Retinopathy:
• 15% of HTN population
 primary response of the retinal arterioles to systemic
hypertension is narrowing(vasoconstriction)
 narrowing – related to severity of HTN , It depends on
pre-existing sclerosis of arterioles(in old)
 HTN Retinopathy is characterized by :(pathogenesis)
• Vasoconstriction
• Leakage(vascular permeability)
• Arteriolosclerosis

3. generalized & focal
arteriolar narrowing
obstruction of
precapillary arterioles

4. caused by abnormal
vascular permeability
flame-shaped
haemorrhage
hard exudates
retinal oedema
swelling of the optic nerve
head
macular star configuration

5. thickening of the vessel wall:
• intimal hyalinization
• medial hypertrophy
• endothelial hyperplasia
changes at arteriovenous
crossing (AV Nipping)
It reflects duration of HTN

7.  Grade 1:
• mild generalized arteriolar attenuation
• broadening of the arteriolar light reflex
 Grade 2:
• more severe, generalized & focal
arteriolar attenuation
• deflection of veins at
arteriovenous crossings
(Salus’ Sign)

8. Grade 3: Grade 2 changes plus
• copper-wiring of arterioles
• banking of veins distal to arteriovenous
crossings (Bonnet Sign)
• tapering of veins on either side of the
crossings (Gunn Sign)
• right-angled deflection of veins(salu’s
sign)
• Retinal edema
• flame-shaped haemorrhages
• cotton-wool spots
• hard exudates

9. Grade 4:
• all grade 3 changes
• silver-wiring of arterioles
• optic disc swelling

10.  Copper wire arterioles where the central light
reflex occupies most of the width of the arteriole
and Silver wire arterioles where the central light
reflex occupies all of the width of the arteriole,
 Silverwiring: term referring to the fundoscopic appea
rance of blood vessels in which the arterial wall
becomes,so completely opaque that blood column is
not seen and the central light reflex occupies all of th
e width of the arteriole. The light is
completely reflected, yielding a white ‘line,’ likened to
a silver wire, regardless of whether the lumen is occl
uded; arterial patency is
determined by fluorescein angiography.