Hypertensive Retinopathy

Question 1

What is the aetiology of hypertensive retinopathy

Answer 1

• Ocular manifestation of systemic hypertension (140/90mmHg)

Question 2

What are the risk factors of hypertensive retinopathy?

Answer 2

• Genetic Factors
• Diet
• Obesity
• Smoking
• Alcohol
• Family history

Question 3

What is the pathogenesis of hypertensive retinopathy?

Answer 3

• Increased BP leading to vasocnstriction of vessels. This leads to acceleration of
  atherosclerotic changes.
• Ischaemia leads to endothelial wall damage which increases the permeability causing leakage into surrounding tissue.

Question 4

What are the grading system signs of hypertensive retinopathy?

Answer 4

Grade 1: Arteriolar attenuation
Grade 2.1: Broadening of the anteriorlar light reflex
Grade 2.2: All above + Salus’s sign
Grade 2.3 All above + bonnet’s sign, Gunn’s sign and copper wiring
Grade 2.4: All above + silver wiring
Grade 3: All above + haemorrhaes, CWS, Exudates
Grade 4 (malignant hypertension) - 200/130mmHg: Optic disc oedema, macular star

Question 5

What are the symptoms shown if a px had hypertensive?

Answer 5

• Grade 1-3 = Usually asymptomatic

- Grade 4 = Decreased vision, H/A, dip, flashes, positive scotoma

Question 6

What is the management of hypertensive retinopathy?

Answer 6

G1/G2 = routine referral to GP and OP
G3 = Urgent referral to OP
G4 = Emergency referral to A&E