This document discusses hypertensive retinopathy and central retinal artery and vein occlusions. It defines hypertensive retinopathy as fundus changes occurring in patients with systemic hypertension, including retinopathy, choroidopathy, and optic neuropathy. It describes the fundus changes seen in chronic and malignant hypertensive retinopathy. It then discusses central retinal artery occlusion and central retinal vein occlusion, their etiologies, symptoms, signs, and treatments.

1. HYPERTENSIVE RETINOPATHY
CRAO&CRVO
Presentation by:
Rajesh Paudel
Roll No.-39

2. HYPERTENSIVE RETINOPATHY
 It refers to fundus changes
occurring in patients
suffering from systemic
hypertension.
 It includes :
 Retinopathy
 Choroidopathy
 Optic neuropathy

4. CLINICAL TYPES
 Chronic hypertensive retinopathy
 Acute or malignant hypertensive retinopathy

5. FUNDUS CHANGES IN CHRONIC
HYPERTENSIVE RETINOPATHY

6. Generalised/
Focal
narrowing/
attenuation of
arterioles

7. Arteriovenous crossing changes
Salu’s sign : deflection of veins at A-V
crossings

8. Arteriovenous crossing changes
Bonnet sign : banking of veins distal to
A-V crossings

9. Arteriovenous crossing changes
Gunn sign : tapering of veins on either
side of crossings

10. Arteriolar reflex changes
 Bright and thin ,linear blood reflex is
seen normally over the surface of the
arteriole.
 More diffuse & less bright reflex is seen
due to thickening of vessel wall

11. Arteriolar reflex changes
Copper wiring :
reddish brown reflex
of arterioles

12. Arteriolar reflex changes
• Silver wiring :
opaque white
reflex of arterioles
Silver wiring

13. Other changes

14. MALIGNANT HYPERTENSIVE
RETINOPATHY CHANGES

15. Acute hypertensive retinopathy
 Marked arteriolar retinopathy
 Superficial retinal hemorrhage (flame
shaped)
 Focal intraretinal periarteriolar
transudates
 Cotton wool spots
 Development of microaneurysm , shunt
vessels , collaterals

16. Acute hypertensive choroidopathy
Elschnig’s spots:
 Black spots
surrounded by
yellow halos
 Due to clumping and
atrophy of infarcted
pigment epithelium

17. Acute hypertensive choroidopathy
Siegrist streaks:
hyperpigmented flecks
arranged linearly along
choroidal vessels

18. Acute hypertensive choroidopathy
Acute focal retinal pigment epitheliopathy
characterized by focal white spots
Serous neurosensory retinal detachment

19. Acute hypertensive optic neuropathy
Disc edema &
hemorrhages on the
disc and
peripapillary retina
Disc pallor

21. MANAGEMENT
 Blood Pressure control
 Risk reduction therapy e.g. cholesterol
lowering drugs
 Anti hypertensive drugs

22. CENTRAL RETINAL ARTERY
OCCLUSION
 It is an ocular emergency
 It occurs due to obstruction at the level of
lamina cribosa
 Usually unilateral
 Male >Female

23. ETIOLOGY OF CRAO
 Emboli
 Atherosclerosis
 Angiospasm
 Raised IOP
 Thrombophilic disorders
 Other causes
 retinal migraine
 hypercoagulation disorders
 sickling hemoglobinopathies

24.  Sudden painless of vision
 There may be history of
transient visual loss
(amaurosis fugax)
SYMPTOMS
 Visual acuity reduced
 Direct pupillary light
absent
 Relative afferent pupillary
defect present
SIGNS

25.  Narrowing of retinal vessels
 Retina becomes milky white : in eyes with cilioretinal
artery part of macula remains normal
 Cherry red spot in the centre of macula (in absence of
cilioretinal artery)
 Cattle tracking
 Atrophic changes :
• Grossly attenuated thread like arteries
• Atrophic appearing retina
• Consecutive optic atrophy
FUNDUS CHANGES OF CRAO

28. TREATMENT OF CRAO
Aggressive treatment of acute episodes
should be done.
 Lower the IOP
 Vasodilators and inhalation of mixture of
5% co2 & 95% O2 or patient is asked to
breathe in a polythene bag
 Fibrinolytic therapy
 IV steroids in case of arteritis
 Laser photodisruption of embolus

29. CENTRAL RETINAL VEIN
OCCLUSION
 It is more common than the artery
occlusion
 Occurs over sixth or seventh decade of life

30. ETIOLOGY OF CRVO
 Pressure on vein by atherosclerotic retinal
artery
 HTN,DM
 Hyperviscosity of blood
 Periphlebitis retinae
 Raised IOP
 Local causes:
o Orbital cellulitis
o Orbital tumors
o Facial erysipelas
o Cavernous sinus
thrombosis

31. TWO TYPES OF CRVO
Ischemic & Non-ischemic

32. NON-ISCHEMIC CRVO
SYMPTOMS
Mild to moderate vision loss
Sudden unilateral blurred vision
SIGNS
Vision:impaired moderately to
severe degree
RAPD: absent

33. FUNDUS EXAMINATION OF NON-
ISCHEMIC CRVO
• Mild venous congestion
and tortuosity
• Few superficial
hemorrhages
• Mild papilloedema
• Mild or no macular
edema

34. ISCHEMIC CRVO
SYMPTOMS
Sudden loss of vision
Usually unilateral
SIGNS
Vision acuity: worse
RAPD : marked

35.  Massive venous
engorgement,congestion
& tortuosity
 Massive retinal
hemorrhage
 Cotton wool spots
 Disc edema & hyperemia
 Macular hemorrhage &
edema
 Neovascularization in
late cases
FUNDUS EXAMINATION OF ISCHEMIC CRVO
Splashed tomato
appearance of fundus

36. MANAGEMENT OF RETINAL VEIN
OCCLUSION
Ocular examination:
 Visual acuity
 IOP recording
 Undilated slit lamp
examination
 Gonioscopy
 Fundus examination
Ocular investigations:
 Goldmann perimetry
 Electroretinograohy
 Fundus fluorescein
angiography (FPA)
 Optical coherence
tomography (OCT)

37. TREATMENT
 Treatment of systemic & ocular associations
such as HTN,DM,hypelipidemias,POAG
 Observation and monitoring : more than 50%
cases of CRVO resolves with almost normal
vision
 Medical therapy:
 Intravitreal anti-VEGF (bevacizumab,
ranibizumab)
 Intravitreal triamcinolone
 Laser therapy
 Pars Plana Vitrectomy