Hypertensive Retinopathy

Question 1

Explain the term hypertension

Answer 1

This is where the bp has been over 140/90 on more than 2 occasions

Question 2

Explain the prevalence of hyp retinop

Answer 2

32% men 30% women

Question 3

What are the risk factors of hbp

Answer 3

Smoking, obesity, race, age

Question 4

Explain the arteriolar response in hypertension and av ratio changes?

Answer 4

Vasoconstriction and the av ratio reduces (normal-2/3)

Question 5

Explain atherosclerosis

Answer 5

This is where there is a decline of muscular and elasticity in the arteriolar wall which leads to a hardening and thickening of the walls and hence thy ant respond as well to hbp

Question 6

What happens to the light reflex with arteriosclerosis?

Answer 6

As the walls harden with plaque the light reflex loses its brightness and becomes broader and diffused

Question 7

Explain copper wiring

Answer 7

This is where atherosclerosis had built up so much that there’s only a narrow space for blood to travel in the artery. The brightness is more and more diffused but then during fundoscopy the light reflects off the artery and you see a diffused red/brown light

Question 8

Explain silver wiring

Answer 8

The arteriolar wall is completely opaque and you get a bright reflex reflecting off

Question 9

What does hypertension damage more and which signs are shown?

Answer 9

Hypertension breaks the blood retinal barrier by compromising the tight junctions and increasing permeability which allow harmful things to get in which lead to blood, plasma and lipids coming in.
This leads to haemorrhages, oedema and exudates

Question 10

What are the sx of hyp ret

Answer 10

It’s a symptomatic but extreme cases leads to blur due to swelling at ONH and macula oedema

Question 11

How do the signs of hypertensive ret appear?

Answer 11

As bilateral and symmetrical.

Question 12

What is the first sign of hypertension ret

Answer 12

Narrowing. Normal av ratios are 2/3 but the arteriolar walls narrow which narrows them to 1/2

Question 13

Explain tortuousity

Answer 13

This is where there are changes in the structure of vessel walls. This is a sign of changes but shouldn’t be used in isolation to diagnose someone with hypertension ret

Question 14

What’s nipping (gunna sign)

Answer 14

Thinner Walled venules compressed by arterioles

Question 15

What’s salus sign?

Answer 15

Deflection and tapering (changing direction and thinning)

Question 16

What are myelinated fibres?

Answer 16

Blood vessels sit underneath the nerve fibre layer. Nerve fibre layers are transparent but when they’re opaque they are myelinated

Question 17

Where’s the hidden layer of blood vessels?

Answer 17

Between the inner nuclear and outer plexiform

Question 18

Where do flame haemorrhages occur?

Answer 18

Blood vessels leaking in NFL and the shape is an arcuate design because it follows the NFL shape. Follows the shape of diverging path or ganglion cell axons

Question 19

Where are dot and blot? and explain their characteristics

Answer 19

They are leaking within the inner nuclear and outer plexiform and because the blood is squashed in the middle the shape doesn’t change from a dot

Question 20

What leads to oedema?

Answer 20

Leaking of vessels into the tissue, causes oedema which causes thickening and elevation of retinal surface which causes a swelled appearance

Question 21

explain the characteristics of hard exudates?

Answer 21

Well defined, yellow/white, develops around vesssels, clustered together, form in the outer plexiform and because of exudates from everything (blood, plasma and lipid), take time to develop and less likely to resolve after exudation stops

Question 22

Explain soft exudates:

Answer 22

White, fluffy, NFL, hide vessel that are under and show places where there isn’t enough blood because of blocked arterioles which is due to damage because of hbp

Question 23

When there’s an increase of axoplasmic material with soft exudates, what happens?

Answer 23

Swelling of neural tissue in NFL leading to cell death but cotton wool spots disappear but damage is already done and visual field won’t disappear

Question 24

Explain how you find optic disc swelling?

Answer 24

Edges blur, vessels travel in and sticking out of the ONH. REFER

Question 25

What is the differential diagnosis of hyp ret?

Answer 25

Diabetic retinopathy which is more educative and with more haemorrhaging and oedema.
Also retinal vein occlusion which is unilateral

Question 26

What is the management of hyp ret?

Answer 26

Refer to gp for management for their diet and lifestyle and also to check for other diseases. Medication such as calcium channel blockers and ace inhibitors (ramipril and amplodipine).

• moderate: ring and see if urgent
• moderate/severe: refer urgent. (Associated with risk of stroke and heart disease)

Question 27

Explain hyp ret classification

Answer 27

• none: no signs
• mild: narrowing, nipping, copper wiring
• moderate: flame, dot/blot, cotton wool, hard exudates
• severe: all including disc swelling