Hypertensive Retinopathy

Question 1

What is Hypertensive Retinopathy?

Answer 1

Ocular manifestation of systemic hypertension, where high blood pressure affects the retinal blood vessels.

Question 2

What is considered normal blood pressure?

Answer 2

Less than 120/80 mmHg.

Question 3

What is Stage 1 Hypertension?

Answer 3

Blood pressure between 140-159/90-99 mmHg.

Question 4

What are the features of Hypertensive Retinopathy?

Answer 4

Tortuous vessels, Venous compression at AV crossing, Focal arteriolar narrowing, Arteriosclerotic changes, Flame-shaped haemorrhages.

Question 5

What are the features of Accelerated Hypertension in the eye?

Answer 5

Cotton wool spots, Disc oedema, Macular star of exudates.

Question 6

What are the features of severe Hypertensive Retinopathy?

Answer 6

Swollen disc, Macular star, Cotton wool spots, Dilated retinal veins, Tortuous vessels, Macular oedema.

Question 7

What is Grade 1 Hypertensive Retinopathy?

Answer 7

Mild narrowing or sclerosis of retinal arterioles.

Question 8

What is Grade 2 Hypertensive Retinopathy?

Answer 8

Moderate to marked sclerosis of retinal arterioles, exaggerated light reflex (copper wiring), venous compression at AV crossings (nipping).

Question 9

What is Grade 3 Hypertensive Retinopathy?

Answer 9

Retinal oedema, cotton wool spots, sclerosis of retinal arterioles.

Question 10

What is Grade 4 Hypertensive Retinopathy?

Answer 10

All of the Grade 3 signs plus disc oedema.

Question 11

What are the key differences between Hypertensive and Diabetic Retinopathy?

Answer 11

Hypertensive Retinopathy: Few haemorrhages, rare oedema/exudates, multiple cotton wool spots, flame-shaped haemorrhages, abnormal retinal arteries. Diabetic Retinopathy: Multiple haemorrhages, extensive oedema, few cotton wool spots, dot and blot haemorrhages, abnormal retinal veins and capillaries.

Question 12

What are flame-shaped haemorrhages?

Answer 12

Nerve fibre haemorrhages that are a sign of hypertensive retinopathy.

Question 13

How is Grade 1 or 2 Hypertensive Retinopathy managed?

Answer 13

Non-urgent referral to the GP.

Question 14

How is Grade 3 Hypertensive Retinopathy managed?

Answer 14

Urgent referral to an ophthalmologist.

Question 15

How is Grade 4 Hypertensive Retinopathy managed?

Answer 15

Emergency referral due to the presence of disc oedema.

Question 16

What is the macular star in Hypertensive Retinopathy?

Answer 16

A radiating pattern of exudates around the macula, seen in severe cases.

Question 17

What is arteriosclerotic change in Hypertensive Retinopathy?

Answer 17

The thickening and hardening of the retinal arterioles, causing light reflex changes.

Question 18

What is venous compression at AV crossings?

Answer 18

A sign of Hypertensive Retinopathy where veins are compressed by arteries at the arteriovenous crossings, also called ‘nipping.’

Question 19

What are cotton wool spots in Hypertensive Retinopathy?

Answer 19

Areas of retinal ischemia, where nerve fibre layers are damaged.

Question 20

How is blood pressure categorized?

Answer 20

Normal: <120/80 mmHg, Prehypertension: 120-139/80-89 mmHg, Stage 1 Hypertension: 140-159/90-99 mmHg, Stage 2 Hypertension: >160/>100 mmHg.