hypertensive retinopathy, ghtn ocular changes, hypertensive choroidopathy, clinical features, pathognomonic signs, management

1. A.R. Shaan
House Surgeon
S1 Unit

2. 
Hypertensive retinopathy

Hypertensive optic neuropathy

Hypertensive choroidopathy

3. 


Fundus changes in systemic
hypertension
first described by Liebreich in
1859.
Marcus Gunn described the
changes in retinal vessels noted
with hypertension - 1898

4. 
Vasoconstriction

Arteriosclerosis

Increased vascular permeability

5. 
Grade I
 Mild generalised
arteriolar
attenuation
 Broadening of
arteriolar light
reflex
 Vein
concealment

6. 
Grade II
 Marked
generalised
narrowing and
focal attenuation
of artertioles
 Salus‟ Sign
(deflection of
veins at AV
crossings)

7. 
Grade III
 Grade II changes
 Copper wiring of
arterioles
 Bonnet Sign
(banking of veins
distal to av
crossings)
 Gunn Sign
(tapering of vein
on either side of
av crossings)
 Flame shaped
haemorrhages,
 Cotton wool spots
 Hard exudates
Gunn Sign
Bonnet sign

8. 
Grade IV
 Grade III
charges
 Silver wiring
of arterioles
 Papilloedema

10. 
Hypertension with senile sclerosis

Hypertension without sclerosis

Hypertension with compensatory sclerosis

Malignant hypertension

11. 
Hypertension with senile sclerosis
 Elderly ( >50)
 Fundus : augmented arteriosclerotic retinopathy

12. 
Hypertension without sclerosis




Young
Exposure to raised blood pressure for a short duration
No retinal signs
No papilloedema/exudates

13. 
Hypertension with compensatory arteriolar
sclerosis




Young
Prolonged bening hypertension
Proliferative & fibrous changes media
“albiminuric / renal retinopathy”

14. 
Malignant Hypertension





Marked arteriolar narrowing
Papilloedema
Retinal edema over posterior pole
Superficial flame shaped hemorrhages
Abundance of cotton wool patches

15. 
BP >160/100mm Hg> 200/130mm Hg

Narrowing of nasal
arterioles-generalised


Cotton wool spots;
retinal
hemmorhagesretinal hypoxia
„Macular star‟ – „flat
macular detachment‟

16. 


Papilloedema or bilateral disc swelling
Papilloedema secondary to hypertension
usually resolve following good control of
blood pressure although some developed disc
pallor
Longstanding chronic hypertension may
result in retinal nerve fibre loss.

17. 


choroidal
ischaemia
choroidal vascular
sclerosis
Elschnig spots
representing focal
areas of
degenerative
retinal pigment
epithelium

18. 

Prompt control of BP
Grade IV retinopathy/ Papilloedema: matter of
urgent referral