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1. OCULAR MANIFESTATION IN
SYSTEMIC DISEASES

2. TOPICS OF DISCUSSION
OCULAR MANIFESTATION OF
• HYPERTENSION
• DIABETICS
• HIV
• THYROID
• TB
• LEPROSY
• SARCOIDOSIS
• MISCELLANEOUS

3. OCULAR
MANIFESTATION
IN
HYPERTENSION
G.SRUJANA

4. CONTENTS
• PATHOGENESIS
• EFFECTS
• CLINICAL TYPES
• STAGING
• MANAGEMENT
• PREGNANCY INDUCED HTN

5. ANATOMY OF VESSELS
RETINAL ARTERIOLES-EXHIBIT AUTOREGULATORY MECHANISMS AND TIGHT
JUNCTIONS TO MAINTAIN BLOOD OCULAR BARRIER
CHOROIDAL ARTERIOLES-HAVE FENESTRATIONS
OPTIC NERVE –HEAD VESSELS EXHIBIT INTERMEDIARY
CHARACTERISTICS WITH AUTOREGULATION
HYPERTENSION
LONGTERM MEDICAL CONDITION IN WHICH BLOOD PRESSURE IN
ARTERIES IS PERSISTENTLY ELEVATED

6. OCCULAR MANIFESTATIONS
•HYPERTENSIVE RETINOPATHY
•HYPERTENSIVE OPTIC NEUROPATHY
•HYPERTENSIVE CHOROIDOPATHY

7. PATHOGENESIS
• VASOCONSTRICTION
• ARTERIOSCLEROSIS
• INCREASED VASCULAR PERMEABILITY

9. .VASOCONSTRICTION - PRIMARY RESPONSE OF RETINAL
ARTERIOLES TO RAISED BP IS NARROWING
• RELATED TO SEVERITY OF HTN
• ARTERIOSCLEROTIC CHANGES - REFLECTS THE DURATION
OF HTN; RESULTS FROM THICKENING OF VESSEL WALL &
MANIFEST AS CHANGES IN ARTERIOLAR LIGHT REFLUX & A-V
NICKING
• INCREASED VASCULAR PERMEABILITY- RESULTS FROM
HYPOXIA
• RESPONSIBLE FOR HEAMORRHAGES , EXUDATES & RETINAL
OEDEMA

11. CLINICAL TYPES
• FUNDUS CHANGES CAN BE DESCRIBED AS
• 1) CHRONIC HYPERTENSIVE RETINOPATHY
• 2) MALIGNANT OR
ACUTE HYPERTENSIVE RETINOPATHY

12. CLINICAL TYPES
• CHRONIC HYPERTENSIVE
RETINOPATHY
* HTN WITH SENILE SCLEROSIS
* HTN WITH OUT SCLEROSIS
* HTN WITH COMPENSATORY
ARTERIOSCLEROSIS

13. HTN WITH SENILE SCLEROSIS
• HTN WITH SENILE SCLEROSIS
• ELDERLY (>50)
• FUNDUS- AUGMENTED ARTERIOSCLEROTIC RETINOPATHY
• HTN WITH OUT SCLEROSIS
• YOUNG
• EXPOSURE TO RAISED BP FOR A SHORT DURATION
• NO RETINAL SIGNS
• NO PAPILLOEDEMA / EXUDATES

14. HTN WITH COMPENSATORY ARTERIOLAR
SCLEROSIS
• YOUNG INDIVIDUALS
• PROLONGED BENIGN HTN ASS. ALONG BENIGN
NEPHROSCLEROSIS
• PROLIFERATIVE & FIBROUS CHANGES IN MEDIA
• FUNDUS CHANGES HAVE BEEN DESCRIBED AS
ALBUMINURIC OR RENAL RETINOPATHY

15. FUNDUS CHANGES IN CHRONIC
HYPERTENSIVE RETINOPATHY
• GENERALISED ARTERIOLAR NARROWING
• FOCAL ARTERIOLAR NARROWING
• SUPERFICIAL RETINAL HEAMORRHAGE(FLAME SHAPED)
• HARD EXUDATES – YELLOWISH WAXY SPOTS , ARRANGED IN
MACULAR FAN OR MACULAR STAR
• COTTON WOOL SPOTS – SOFT EXUDATES

16. ARTERIOLAR REFLUX CHANGES
• A) BRIGHT AND THIN , LINEAR BLOOD REFLEX-IN NORMAL CONDITION
• B) MORE DIFFUSE AND LESS BRIGHT REFLEX- DUE TO VESSEL WALL
THICKENING
• C)COPPER WIRING- REDDISH BROWN REFLEX DUE TO PROGRESSIVE
SCLEROSIS AND HYALINISATION
• D)SILVER WIRING- OPAQUE WHITE REFLEX , DUE TO CONTINUED
SCLEROSIS

17. COPPER WIRE SIGN

19. AV NICKING
• A) SALU’S SIGN- DEFLECTION OF VEINS AT THE ARTERIO VENOUS CROSSING
• B) BONNET SIGN- BANKING OF VEINS DISTAL TO AV CROSSING
• C) GUNN SIGN – TAPPERING OF VEINS ON EITHER SIDE OF THEIR CROSSING

20. MALIGNANT OR ACUTE HTN
ACUTE HYPERTENSIVE RETINOPATHY
*MARKED ARTERIOLAR NARROWING
*SUPERFICIAL RETINAL HEAMORRHAGES
*FOCAL INTRARETINAL PERIARTERIOLAR TRANSDUATES
*COTTON WOOL SPOTS
*MICRO ANEURYSMS, SHUNT VESSELS AND COLLATERALS DEVELOP

21. ACUTE HTN CHOROIDOPATHY
• ACUTE FOCAL RETINAL PIGMENT EPITHELOPATHY
• ELSHNIG’S SPOTS
• SIEGRIST STREAKS
• SEROUS NEUROSENSORY RETINAL DETATCHMENT
SIEGRIST STREAKS

23. ACUTE HTN OPTIC
NEUROPATHY
• DISC OEDEMA AND
HAEMORRHAGE
• DISC PALLOR

24. STAGING
• KEITH AND WAGNER CLASSIFICATION
• SCHEIE CLASSIFICATION
• WONG AND MC INTOSH CLASSIFICATION

27. MANAGEMENT
• MILD HYPERTENSIVE RETINOPATHY
• --- REQUIRES BLOOD PRESSURE CONTROL
ONLY
• MODERATE HYPERTENSIVE RETINOPATHY
• ----PATIENT IN ADDITION TO BP CONTROL
BENEFIT FROM FURTHER ASSESSMENT OF VASCULAR RISK FACTORS
AND IT INDICATE RISK REDUCTION THERAPY
• ACCELERATED HYPERTENSIVE RETINOPATHY
• ----NEED URGENT ANTI HYPERTENSIVE
MANAGEMENT

28. PREGNANCY INDUCED HTN
• KNOWN AS TOXAEMIA OF PREGNANCY ,IS A DISEASE OF
UNKNOWN ETIOLOGY CHARACTERISED BY RAISED BP,
PROTEINURIA AND GENERALISED OEDEMA
• RETINAL CHANGES---- LIABLE TO ACCESS WHEN BP>160/100 mm of
Hg
• ----MARKED WHEN > 200/130 mm of Hg

29. PREGNANCY INDUCED HTN
MANAGEMENT
• IN PREORGANIC STAGE WHEN PATIENT RESPOND WELL TO
CONSERVATIVE THERAPY, THE PREGNANCY MAY CONTINUED
UNDER CLOSED OBSERVATION.
• ADVENT OF HYPOXIA RETINOPATHY --- INDICATE TERMINATION OF
PREGNANCY