Hypertension

Question 1

What is hypertension?

Answer 1

Raised blood pressure, it is a systemic condition that affects vasculature.

Question 2

Normal BP Value?

Answer 2

140/90mmHg

Question 3

3 phases of hypertension are?

Answer 3

1. Vasoconstrictive phase
2. Sclerotic phase
3. Exudative phase

Question 4

What does hypertension lead to in the eye?

Answer 4

Autoregulation will result in vasoconstriction as AV narrowing, later persistent high BP leads to thickening and toughening of walls and loss of muscle cells. Arterial light reflex changes at AV crossing. Blood retinal barrier disturbed due to loss of smooth muscles and endothelial cells.

Question 5

Complications associated with hypertension?

Answer 5

1. Microaneurysms
2. CRA & CRV Occlusion
3. Epiretinal membrane

Question 6

In exudative phase blood retinal barrier is compromised, what major changes are associated with this?

Answer 6

1. Retinal oedema
2. Hard exudates
3. CWS
4. Retinal hemorrhages
5. FIPTs
6. IRMA

Question 7

FIPTs CWS?

Answer 7

FIPT: deep in the structures
CWs: Superficial in nerve fiber layer.

Question 8

Grade 1 & 2 are chronic changes grade 3 & 4 are acute changes why?

Answer 8

Grade 1 and 2: changes remain even after pressures are normal again.
Grade 3 and 4: changes do not remain after pressures are normal again.

Question 9

Disc swelling in the eye with hypertensive retinopathy is linked to?

Answer 9

High risk of organ damage.

Question 10

What is Gunn’s sign?

Answer 10

Blanching/ nipping of vessels

Question 11

Salus sign?

Answer 11

Artery overlying vein

Question 12

Bonnet sign?

Answer 12

Calibre of underlying vein is restricted by overlying artery.

Question 13

What is focal arteriole narrowing is it seen in hypertension?

Answer 13

Yes, this is when the artery is narrowing

Question 14

What is copper wiring?

Answer 14

The walls of the arterioles become thickened and sclerosed and reflect more light on examination.

Question 15

What is IRMA?

Answer 15

Intraretinal microvascular abnormalities
This are dilated looping vessels but not neovascularization

Question 16

Why do exudates form?

Answer 16

They form secondary to leakage from vessels and oedema.

Question 17

How to tell is a disc is swollen?

Answer 17

Indistinct edges

Question 18

What common feature is seen at the macular with hypertension?
And what does it mean?

Answer 18

Macular star- fluid leaks and exudates form in a star like pattern radiating from the center of the macular.

Question 19

What causes macroaneurysm in high BP?

Answer 19

Due to damaged arteriole vessel walls.

Question 20

Hypertensive choroidopathy occurs in?

Answer 20

Severe hypertension and young ppl.

Question 21

Hypertensive choroidopathy is associated with?

Answer 21

Renal disease, toxemia during preganancy or collagen vascualar.

Question 22

Signs of Hypertensive choroidopathy

Answer 22

1. Elschnig’s spot
2. Siegrist streak
3. May develop neurosensory retina

Question 23

What is elschnig spots?

Answer 23

Black pigmented spots with haloes around them.
Seen in Hypertensive choroidopathy

Question 24

What is siegrist streaks?

Answer 24

Hyperpigmented streaks around choroidal vessels - indicate underlying damage to the core of vasculature.

Question 25

2 causes of disc oedema?

Answer 25

1. Raised intracranial pressure
2. Disc Ischemia

Question 26

Retinal emobli is what colour?

Answer 26

White

Question 27

Management of high BP?

Answer 27

Refer for high BP.

Question 28

Management of mild hypertensive retinopathy? and signs?

Answer 28

general arteriole narrowing, av nipping, routine referal to GP for hypertension.

Question 29

Management of moderate hypertensive retinopathy? and signs?

Answer 29

Flame/ bot shaped hemorrhages, microaneurysms, CWs, hard exudates.

Question 30

Severe/ malignant hypertension management and signs?

Answer 30

Av crossing, AV nipping, flame/ blot shaped hemorrhages, CWs, hard exudates, OPTIC DISC SWELLING.