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Hypertensive Retinopathy: By: Dr. Naveen Nischal G

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This document discusses hypertensive retinopathy, which is retinal damage caused by high blood pressure. It describes the various stages and classifications of hypertensive retinopathy and associated signs seen on eye examination. These include generalized retinal arteriolar narrowing, focal arteriolar narrowing, hemorrhages, exudates, and in severe cases, optic disc swelling. The document also notes that hypertensive retinopathy indicates target organ damage and its presence should prompt more aggressive blood pressure management.

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Hypertensive Retinopathy: By: Dr. Naveen Nischal G

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Naveen Nischal
28 views16 pages
This document discusses hypertensive retinopathy, which is retinal damage caused by high blood pressure. It describes the various stages and classifications of hypertensive retinopathy and associated signs seen on eye examination. These include generalized retinal arteriolar narrowing, focal arteriolar narrowing, hemorrhages, exudates, and in severe cases, optic disc swelling. The document also notes that hypertensive retinopathy indicates target organ damage and its presence should prompt more aggressive blood pressure management.

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Hypertension

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Hypertensive Retinopathy

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This document discusses hypertensive retinopathy, which is retinal damage caused by high blood pressure. It describes the various stages and classifications of hypertensive retinopathy and associated signs seen on eye examination. These include generalized retinal arteriolar narrowing, focal arteriolar narrowing, hemorrhages, exudates, and in severe cases, optic disc swelling. The document also notes that hypertensive retinopathy indicates target organ damage and its presence should prompt more aggressive blood pressure management.

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© All Rights Reserved
Download as PPTX, PDF, TXT or read online from Scribd
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28 views16 pages

Hypertensive Retinopathy: By: Dr. Naveen Nischal G

Uploaded by

Naveen Nischal
This document discusses hypertensive retinopathy, which is retinal damage caused by high blood pressure. It describes the various stages and classifications of hypertensive retinopathy and associated signs seen on eye examination. These include generalized retinal arteriolar narrowing, focal arteriolar narrowing, hemorrhages, exudates, and in severe cases, optic disc swelling. The document also notes that hypertensive retinopathy indicates target organ damage and its presence should prompt more aggressive blood pressure management.

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HYPERTENSIVE

RETINOPATHY
By : Dr. Naveen Nischal G
Introduction

■ Hypertension is the leading risk factor for cardiovascular disease (CVD) and
mortality worldwide
■ Causes :
1. Hypertensive Retinopathy
2. Hypertensive Choroidopathy
3. Hypertensive Optic Neuropathy.
Risk Factor

■ Hypertension is also a major risk factor for many other eye diseases like
1. Development and progression of diabetic retinopathy
2. Retinal vein occlusion
3. Retinal arterial macroaneurysm
4. Age-related macular degeneration
5. Glaucoma.
Definition and Classification

■ Retinopathy is the most common manifestation of hypertension which develops due


to acute and/or chronic elevations in blood pressure.
■ Broadly divided into various phases :
a. Vasoconstrictive Phase
b. Sclerotic Phase
c. Exudative Phase
d. Malignant Hypertension
■ Elevated blood pressure does not fully explain all the pathophysiological
mechanisms of hypertensive retinopathy.
■ Other processes involved in the pathogenesis of hypertensive retinopathy signs
include inflammation, endothelial dysfunction, abnormal angiogenesis, and
oxidative stress.
Classification

■ Keith Wagner Baker system :


a. Grade 1 : Mild generalized retinal arteriolar narrowing.
b. Grade 2 : Focal arteriolar narrowing and arteriovenous nipping. A ‘copper wiring’
opacified appearance of arteriolar walls may be seen.
c. Grade 3 : Grade 2 plus retinal haemorrhages, exudates and cotton wool spots.
d. Grade 4 : Severe grade 3 plus optic disc swelling; this is a marker of malignant
hypertension.
Newer Classification

1. None: no detectable signs.


2. Mild: Generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous
nicking, arteriolar wall opacification (silver or copper wiring), or a combination of
these signs.
3. Moderate: Hemorrhages (blot, dot, or flame-shaped), microaneurysms, cotton-wool
spots, hard exudates, or a combination of these signs.
4. Malignant: Signs of moderate retinopathy in combination with optic disc swelling, in
the presence of severely elevated blood pressure.
■ Presence of Hypertensive retinopathy, with Left Ventricular Hypertrophy and Renal
Impairment, is an indicator of target organ damage.
■ Its presence should be an indication for a more aggressive approach in managing
these hypertensive patients.
Epidemiology

■ Age
■ Gender – Men more than Women
■ Ethnicity – Chinese more than whites
■ Blood Pressure Levels
■ Generalized retinal arteriolar narrowing and arteriolar nicking – Markers of chronic
hypertension.
■ Focal arteriolar narrowing, retinal hemorrhages, microaneurysms and cotton-wools
spots – Mirror short term blood pressure changes.
Hypertensive Choroidopathy

■ Mechanism of hypertensive choroidopathy - Choroidal ischemia which has effects


on the retinal pigment epithelium and retina.
■ The choroidal vessels may undergo fibrinoid necrosis at the level of the choroidal
capillaries in the presence of elevated blood pressure.
■ Elschnig spots - round, deep, and gray-yellow patches at the level of the retinal
pigment epithelium
■ Siegrist streaks - inear hyperpigmented streaks along choroidal arteries
■ In severe cases, there may also be serous retinal detachment which can lead to
vision loss.
Hypertensive Optic Neuropathy

■ Bilateral optic disc swelling or papilloedema is commonly caused by accelerated or


malignant hypertension, representing the “malignant hypertensive retinopathy”
stage in the above classification.
■ Why optic disc swelling occurs is still uncertain.
■ Ischemia, Raised Intracranial pressure, Hypertensive encephalopathy all are
possible mechanisms.
■ Need urgent anti hypertensive management.

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