Scribd Logo
Upload

Welcome to Scribd!

  • 87 views

    Hypertensive Retinopathy

    Uploaded by

    Ulquiorra Schiffer
    Hypertensive retinopathy results in changes to the retina, choroid, and optic nerve due to severe hypertension. The main changes include arteriolar narrowing, AV nicking, cotton wool spots, and retinal hemorrhages. Chronic hypertensive retinopathy is usually asymptomatic and seen in older patients with arteriosclerotic changes. Malignant hypertension causes rapid damage and is associated with renal insufficiency. Treatment involves strict blood pressure control and assessing for other conditions like high cholesterol.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Hypertensive Retinopathy

    Uploaded by

    Ulquiorra Schiffer
    87 views24 pages
    Hypertensive retinopathy results in changes to the retina, choroid, and optic nerve due to severe hypertension. The main changes include arteriolar narrowing, AV nicking, cotton wool spots, and retinal hemorrhages. Chronic hypertensive retinopathy is usually asymptomatic and seen in older patients with arteriosclerotic changes. Malignant hypertension causes rapid damage and is associated with renal insufficiency. Treatment involves strict blood pressure control and assessing for other conditions like high cholesterol.

    Original Description:

    hypertensive retinopathy

    Original Title

    hypertensive retinopathy

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Hypertensive retinopathy results in changes to the retina, choroid, and optic nerve due to severe hypertension. The main changes include arteriolar narrowing, AV nicking, cotton wool spots, and retinal hemorrhages. Chronic hypertensive retinopathy is usually asymptomatic and seen in older patients with arteriosclerotic changes. Malignant hypertension causes rapid damage and is associated with renal insufficiency. Treatment involves strict blood pressure control and assessing for other conditions like high cholesterol.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    87 views24 pages

    Hypertensive Retinopathy

    Uploaded by

    Ulquiorra Schiffer
    Hypertensive retinopathy results in changes to the retina, choroid, and optic nerve due to severe hypertension. The main changes include arteriolar narrowing, AV nicking, cotton wool spots, and retinal hemorrhages. Chronic hypertensive retinopathy is usually asymptomatic and seen in older patients with arteriosclerotic changes. Malignant hypertension causes rapid damage and is associated with renal insufficiency. Treatment involves strict blood pressure control and assessing for other conditions like high cholesterol.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 24

    HYPERTENSIVE

    RETINOPATHY
    ANGEL DAS
    Hypertensive Retinopathy
    • Fundus changes that occur in patients with severe hypertension
    • Clinical presentation includes changes of
    -Retinopathy
    -Choroidopathy
    -Optic neuropathy
    pathogenesis
    • 3 factors play role in pathogenesis
    1. Vasoconstriction
    2. Arteriosclerotic changes
    3. Increased vascular permeability
    Pathophysiology

    Systemic chronic Narrowing of


    Arteriosclerosis
    hypertension retinal arterioles

    Increased
    Retinal
    Hypoxia capillary
    Ischaemia
    permeability

    Focal Retinal Oedema, retinal


    haemorrhage,cotton wool spots, hard
    exudates
    Clinical types
    Clinically hypertensive fundus changes can be described as
    • Chronic hypertensive retinopathy
    • Malignant/acute hypertensive retinopathy
    Chronic hypertensive retinopathy
    • Usually asypmtomatic
    • Clinical situations include
    1. Hypertension with involutinary ( senile)
    sclerosis:
    elderly patients (> 50 yrs ),fundus changes comprise augmented arteriosclerotic retinopathy.
    2.Chronic hypertension with compensatory
    arteriolar sclerosis

    • Seen in young individuals


    • young arterioles respond to HTN by prolifrative and
    fibrous changes in media
    • In the kidneys there will be chronic
    glomerulonephritis
    • so known as albuminuric or renal retinopathy
    Normal Fundus
    Fundus Changes

    • Generalized arteriolar narrowing


    • Focal arteriolar narrowing
    • A-V nicking
    -hallmark of HR
    • Salu’s sign – deflection of veins at A-V crossing
    • Bonnet sign – banking of veins distal to A-V crossing
    • Gunn sign – tapering of veins on either side of crossing
    • Arteriolar Reflex Changes
    -bright, thin, linear reflex –Normal
    -diffuse, less bright reflex –Grade I/II
    -Copper wiring
    -Silver wiring
    • Superficial retinal haemorrhages
    • Hard exudates
    • Cotton wool spots
    Malignant hypertension
    • rapid progression of the hypertensive state in a patient with relatively young
    arterioles undefended by sclerosis
    • There will be retinopathy , choroidopathy & optic neuropathy
    • It is asso. With renal insufficiency
    Choroidopathy

    • Elschnig’s spots- focal areas infarcted retinal pigment


    epithelium
    • Siegrist streaks- due to fibrinoid necrosis in malignant
    hypertension
     Grade I

     Mild generalised arteriolar


    attenuation

     Broadening of arteriolar
    light reflex

     Vein concealment
     Grade II

     Marked generalised narrowing


    and focal attenuation of
    artertioles

     Salus’ Sign (deflection of veins


    at AV crossings)
     Grade III
    Bonnet sign Gunn Sign

     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
     Grade IV

     Grade III changes

     Silver wiring of
    arterioles

     Papilloedema
    • Scheie classification
    Management
    Mild HR BP control only

    Moderate HR BP control
    +
    Assess cholesterol levels & if indicated cholesterol
    lowering agents
    Accelerated HR Urgent anti hypertensive management by stepwise
    control of BP over a few hours
     BP >160/100mm Hg- >
    200/130mm Hg

     Narrowing of nasal arterioles-


    generalised

     Cotton wool spots; retinal


    hemmorhages- retinal hypoxia

     ‘Macular star’ – ‘flat macular


    detachment’
    Management
    • Changes are reversible , disappear after delivery
    • In preorganic stage : conservative treatment , pregnancy is continued under
    close observation
    • Advent of hypoxic retinopathy( cotton wool spots,hemorrhages,retinal
    edema): indication for termination of pregnancy ,otherwise permanent visual
    loss or even loss of life may occur.

    You might also like