Hypertensive Retinopathy

Question 1

What is hypertensive retinopathy?

Answer 1

• Microvascular damage from elevated blood pressure
• Primary response of arterioles is vasoconstriction – when BP goes up, vessels constrict
• Inner blood-retinal barrier is disrupted in localised areas with increased vascular permeability – little areas of ischaemia and little areas of fluid build up

Question 2

Hypertensive retinopathy grading?

Answer 2

• Grade 1 – mild generalised arteriolar narrowing
• Grade 2 – focal narrowing (just in one small area), AV nipping, copper wiring
• Grade 3 – Gr 2 + haemorrhages (dot, blot & flame), exudates, cotton wool spots, “macular star” (star at macular of exudates)
  –> Chronic retinal oedema may result in deposition of hard exudate around fovea as a ‘macular star’
• Grade 4 – optic disc swelling
  o Sign of malignant hypertension – BP v high – risk factor for stroke

Question 3

Hypertensive retinopathy symptoms?

Answer 3

• Pxs may complain of headaches and (intermittent) loss of vision

Question 4

Management of hypertensive retinopathy?

Answer 4

• REFER TO GP FOR BP CHECK – if concerned about grade 1 or 2
• URGENT REFERRAL TO HES IF GRADE 4 (or 3)
  URGENT REFERRAL - vascular causes w/ sudden loss of vision (e.g. hypertensive retinopathy)