Hypertensive Retinopathy Flashcards
What is high blood pressure?
•BP > 140/90mmHg –> On at least two occasions
For what conditions is high blood pressure a major risk factor?
•Major risk factor for heart disease, stroke, renal problems and visual impairment
[Changes at the back of the eye may be the first indication that a patient has high blood pressure].
What is malignant hypertension?
This is incredibly high blood pressure (its very rare).
Systolic > 200mmHg
Diastolic > 140mmHg
What are risk factors for high blood pressure?
- Age
- Family history
- Obesity
- Smoking
- African-Caribbean race
What are ocular complications of raised blood pressure?
- Cranial nerve palsies
- Sub-conjunctival haemorrhages
- Hypertensive retinopathy
Is hypertensive retinopathy visible on fundoscopy?
Yes
True or false - early signs or hypertensive retinocpathy are easily overlooked?
True - early signs of hypertensive retinopathy are easily overlooked.
Do systemic dieases such as diabetes present unilaterally or bilaterally?
Bilaterally - i.e. signs are present in both eyes.
True or false - there are different grades of hypertensive retinopathy.
True - the higher you go the more severe the hypertensive retinopathy
What occurs in grade 1 hypertensive retinopathy?
- Arteriosclerosis => hardening or loss of elasticity of small blood vessel walls
- Mild to moderate narrowing or sclerosis of the retinal arterioles
- Vasospasm of arterial walls
ØNormal A/V ratio reduced
•Increased venous tortuosity may also be seen
What is the optometric managment for grade 1 hypertensive retinopathy?
Refer to Gp if not already being treated for hypertension
What will be seen in grade 2 hypertensive retinopathy?
•Moderate to marked narrowing of the arterioles
–>Local and or generalised
- Arteriovenous crossing changes (shown in the image with the black arrows)
- Increase in the light reflex (from copper wire)
- Nipping or Gunn’s sign
- Copper Wire
- Reduced AV ratio
What is nipping or Gunn’s sign?
What is copper wire?
What is the optometric management for grade 2 hypertensive retinopathy?
Refer to GP if not already being treated for hypertension.
What presents with grade 3 hypertensive retinopathy?
What are cotton wool spots and how do they form?
How many cotton wool spots can you see?
With hypertensive retinopathy what shape do haemorrhages tend to be?
Flame shaped
(These are superficial and follow the nerve fibre layer).
How many flame shaped haemorrhages can you see?
True or false - vascualr leakage results in retinal oedema?
True
Why is retinal oedema better viewed via slit lamp Binocular indirect ophthalmoscopy?
Because it provides a stereoscopic view.
What can be used to detect macular oedema other than slit lamp BIO?
An OCT
(Often used to detect subtle macular oedema).
How can hard exudates form?
From vascular leakage
What are hard exudates and what do they look like on the fundus?
Lipo proteins that have been released ( from vascualr leakage).
They have a yellow waxy appearance on the fundus.
Where are hard exudates are present in this picture?
What does chronic macula oedema result in?
A macular star
What is the optometric managment for grade 3 hypertensive retinopathy?
•Rapid referral to GP for cardiovascular check
What presents in grade 4 hypertensive retinopathy?
What symptoms may a px with grade 4 hypertensive retinopathy present with?
Headaches and visual symptoms such as a reduced VA.
What is the optometric managment for grade 4 hypertensive retinopathy and why?
ØRefer to A&E as there is a Risk of ocular, cardiac, renal and cerebral damage
