Hypertensive Retinopathy

Question 1

What is the aetiology/cause of hypertensive retinopathy?

Answer 1

= ocular manifestation of a systemic disorder (hypertension)

Question 2

What are the 6 risk factors of hypertensive retinopathy?

Answer 2

1. Genetic Factors
2. Diet
3. Obesity
4. Smoking
5. Alcohol
6. Family History

Question 3

What is the pathogenesis of hypertensive retinopathy?

Answer 3

1. Vasoconstriction occurs as a primary response to HBP (G1 arteriolar attenuation).
2. Due to reduction in arteries, results in atherosclerotic changes within retinal vessels (G2 Focal attenuation + arteriolar nipping).
3. Problems with vessels + High BP = reduced blood flow -> ischaemia = more damage to vessels = leakage (G3/G4)

Question 4

What are the signs of hypertensive retinopathy?

Answer 4

Vasoconstriction, Arteriosclerotic changes, Vascular changes.

Grade 1: Arteriolar attenuation (narrowing)
Grade 2.1: Broadening of the arteriolar 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 + haemorrhages, CWS, Exudates (180/110mmHg)
Grade 4 (malignant hypertension) - 200/130mmHg: Optic disc oedema, macular star

Question 5

What are the symptoms for hypertensive retinopathy?

Answer 5

Grade 1-3 = usually asymptomatic (unless severe hypertension)

Grade 4 = Decreased vision, H/A, Dip, Scotoma, Photopsia (flashes and floaters)

Question 6

What is the referral for hypertensive retinopathy?

Answer 6

G1/G2 = ROUTINE referral to GP & OP

G3 = URGENT referral to OP, ROTUINE to GP

G4 = EMERGENCY referral to A&E

Question 7

What is the treatment for hypertensive retinopathy?

Answer 7

Anti-Hypertensive Medication (to reduce HBP)

Anti Coagulation Meds (to prevent blood clots)

Question 8

What is the differential diagnosis of hypertensive retinopathy and how would you distinguish between them?

Answer 8

• Diabetic Retinopathy.

DR is more wet i.e. has multiple haem, fewer flame haem, extensive oedema, few CWS. Also has microvascular abnormalities i.e. IRMA

HR has Salus sign etc.

Question 9

How would you know if its hypertensive choroidopathy instead of hypertensive retinopathy?

Answer 9

• BP increases dramatically
• Elshings spots (yellow lesions)
• Siegrist steaks (hyperpigmented red streaks)