Hypertensive Retinopathy

Question 1

What is hypertensive retinopathy?

Answer 1

Damage to the small blood vessels in the retina relating to systemic hypertension, this can either be due to chronic hypertension or can develop quickly malignant hypertension.

Question 2

What are the signs that occur in the retina in response to hypertension in the vessels?

Answer 2

Silver/copper wiring, where the walls of the arterioles become thickened and sclerosed which causes increased reflection of light on examination.

Arteriovenous nipping

(Where the arterioles cause compression of the veins where they cross over, this is due to sclerosis and hardening of the arterioles)

Cotton wool spots are caused by ischaemia and infarction in the retina causing damage to nerve fibres

Hard exudates are caused by damaged vessels leaking lipids onto the retina

Retinal haemorrhages are caused by damaged vessels rupturing and releasing blood into the retina

Papilloedema (due to the ischaemia which leads to optic nerve swelling and blurring of the disc margins)

Question 3

What is used to classify diabetic retinopathy?

Answer 3

Keith wagener
Stage 1= mild narrowing of the arterioles
2= focal constriction of blood vessels and AV nicking
3= cotton wool patches, exudates and haemorrhages
4= papilloedema

Question 4

What is the management of hypertensive retinopathy?

Answer 4

Management is focused on controlling blood pressure and other risk factors- smoking and lipids