Hypertensive Retinopathy

Question 1

What are the 5 artery divisions?

Answer 1

1. Central retinal artery
2. Long posterior
3. Short posterior
4. Anterior Ciliary artery
5. Muscular artery

Question 2

What are the two sources of blood supply to the retina?

Answer 2

• central retinal artery, supplies inner retina
• the choroidal blood vessels supplies outer retina

Question 3

What is Arteriosclerosis?

Answer 3

• Disease of arteries or arterioles
• stiffening of extracellular matrix (cell wall)
  which occurs in response to age, salt intake, cigarette smoking

Question 4

What does Arteriosclerosis result in?

Answer 4

• stiffened/thickened wall
• narrowed arteriolar lumen
• raised BP

Question 5

What is Atherosclerosis?

Answer 5

Narrowing of arteries due to the buildup of fatty deposits in the arteries

Question 6

What happens when the plaque forms?

Answer 6

They can cause emboli in the bloodstream and long term results in vessel occlusion

Question 7

What are the signs of hypertensive retinopathy?

Answer 7

• AV narrowing
• focal changes
• venous nicking/banking
• silver wiring
• microaneurysms
• cotton wool spots
• dot, blot & flame hameorraghes
• exudates/tranduates
• choroidopathy
• acute disc swelling

Question 8

What are exudates?

Answer 8

fluids, cells or other substances that are slowly discharged from blood vessels usually from, inflammed tissues

Question 9

What are transudates?

Answer 9

caused by disturbances of hydrostatic or colloid osmotic pressure

Question 10

What happens during arteriovenous narrowing?

Answer 10

This is an early sign of hypertensive retinopathy. The ratio goes down and less than 2:3

Question 11

What is focal arteriolar narrowing?

Answer 11

In response to BP rising, the vessels spasm causing focal narrowing.
This is also a sign of acute hypertension changes

Question 12

What is papilledema ?

Answer 12

Happens with an increase in intracranial BP resulting in bilateral disc swelling

Question 13

What occurs in acute hypertensive retinopathy?

Answer 13

• focal arteriolar narrowing
• haemorrhages
• microaneurysms
• cotton wool spots
• disc swelling
• hard exudates

Question 14

What occurs in chronic retinopathy?

Answer 14

• generalised arteriolar narrowing
• AV crossing changes
• copper wiring
• silver wiring

Question 15

What are the consequences of hypertensive retinopathy?

Answer 15

• greater risk of central artery occlusion because of emboli
• vein occlusion because of abnormal blood flow

Question 16

What is mild hypertensive retinopathy?

Answer 16

will show/cause generalised retinal arteriolar narrowing and arteriovenous nicking

Question 17

What is moderate hypertensive retinopathy?

Answer 17

will show/cause cotton wool spots and retinal haemorraghes

Question 18

What is malignant hypertensive retinopathy?

Answer 18

will show/cause multiple cotton wool spots, retinal haemorraghes, optic disc swelling and macular star

Question 19

How do you manage hypertensive retinopathy?

Answer 19

Determine if it is acute or chronic, make appropriate GP referral but if there is disc involvement and VA loss refer to ophthalmologist