Hypertensive retinopathy

Hypertensive Retinopathy

1. HYPERTENSIVE RETINOPATHY ANGEL DAS

2. Hypertensive Retinopathy Fundus changes that occur in patients with severe hypertension Clinical presentation includes changes of -Retinopathy - Choroidopathy -Optic neuropathy

3. pathogenesis 3 factors play role in pathogenesis Vasoconstriction Arteriosclerotic changes Increased vascular permeability

4. Pathophysiology

5. Clinical types Clinically hypertensive fundus changes can be described as Chronic hypertensive retinopathy Malignant/acute hypertensive retinopathy

6. Chronic hypertensive retinopathy Usually asypmtomatic Clinical situations include Hypertension with involutinary ( senile) sclerosis: elderly patients (> 50 yrs ),fundus changes comprise augmented arteriosclerotic retinopathy.

7. 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

8. Normal Fundus

9. Fundus Changes Generalized arteriolar narrowing Focal arteriolar narrowing A-V nicking -hallmark of HR

10. 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

11. Arteriolar Reflex Changes -bright, thin, linear reflex –Normal -diffuse, less bright reflex –Grade I /II -Copper wiring -Silver wiring

12. Superficial retinal haemorrhages Hard exudates Cotton wool spots

13. 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

14. Choroidopathy Elschnig’s spots- focal areas infarcted retinal pigment epithelium Siegrist streaks- due to fibrinoid necrosis in malignant hypertension

15. Grade I Mild generalised arteriolar attenuation Broadening of arteriolar light reflex Vein concealment Grading ( Keith & Wegner)

16. Grade II Marked generalised narrowing and focal attenuation of artertioles Salus ’ Sign (deflection of veins at AV crossings )

17. Grade III 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

18. Grade IV Grade III changes Silver wiring of arterioles Papilloedema

19. Scheie classification

20. 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

21. BP >160/100mm Hg- > 200/130mm Hg Narrowing of nasal arterioles- generalised Cotton wool spots; retinal hemmorhages - retinal hypoxia ‘Macular star’ – ‘flat macular detachment’ Retinopathy in PIH

22. 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.