Hypertensive retinopathy Flashcards
What is blood pressure?
The pressure that is exerted by the blood in blood vessels
What do the 2 numbers on blood pressure reading mean?
First number is systolic pressure during systole which is when ventricles contract
Second number is diastolic pressure during diastole when ventricles relax
What is normal blood pressure?
Between 90/60mmHg to 140/90 mmHg
What is hypertension/high bp?
Above 140/90 mmHg on two occasions
What is malignant HTN?
Above 200/140mmHg
Emergency
What can HTN cause?
Heart disease, stroke, renal problems, retinopathy, cognitive decline, premature death
What are the non-modifiable risk factors for HTN?
Age, FH, race (afro-caribbean), pregnancy
Diabetes and HTN=more risk of retinopathy
What are modifiable risk factors of HTN?
Obesity, smoking, alcohol, exercise
What are some ocular complications of HTN?
Sub-conjunctival haemorrhages
Cranial Nerve Palsies
Hypertensive retinopathy
Systemic diseases present bilaterally
What is sub-conjunctival haemorrhage?
Burst blood vessel within the eye, if recurrent then warrants referral to GP for CVD work up
What is hypertensive retinopathy?
Diffuse or focal narrowing of retinal arterioles in response to HTN
What can long term HTN cause?
Arteriolosclerosis
Thickening of arteriolar wall
How many grades of hypertensive retinopathy are there?
4
What is Grade 1 hypertensive retinopathy and how do you manage px?
Mild to moderate narrowing of retinal arterioles , turtousity
A/V ratio reduced (arteries thinner than normal eg. 1/3 ratio instead of 2/3)
Refer to GP is not already being treated
What is Grade 2 hypertensive retinopathy and how do you manage px?
Moderate to marked narrowing of arterioles - Local and/or generalised narrowing
Arteriovenous crossing changes
Copper/metallic appearance, increase in light reflex
Refer to GP is not already being treated
What sort of arteriovenous changes will you see in Grade 2?
Nipping/gunn’s sign: Thinning of venoule at arteriole crossing,
The hardened artery puts physical pressure on the vein and nips in
Severe AV crossing changes can cause BRVO
This sign may persist even when blood pressure is under control again
What is the copper wire appearance caused by?
Increase in elastic and muscular components of artery wall
The narrow lumen gives a copper reflex
What is silver wire?
Copper wire can become silver wire overtime when the column of blood can no longer be visualised
What is beading?
Beading=changes in the colour of the artery, the risk is that that artery becomes occluded
What is Grade 3 hypertensive retinopathy and how do you manage px?
Arterial narrowing and focal constriction
Cotton wool spots
Retinal haemorrhages
Hard exudates
Retinal oedema
Urgent referral to GP to get BP checked
What sort of diastolic BP does patient have in grade 3?
Typically
Dystolic 110-115mmHg
What type of hemorrhages will you see in grade 3?
Flame shaped hemorrhages which follow path of nerve fibre layer
What is Grade 4 hypertensive retinopathy and how do you manage px?
Grade 3 plus optic disc swelling
Exudate at macula= macular star
Refer emergency to A&E
What sort of diastolic BP does patient have in grade 4?
Malignant hypertension
Diastolic
130-140mmHg
Why do you refer Grade 4 to A&E
Risk of ocular, cardiac, renal and cerebral damage
What symptoms will Grade 4 have?
Blurred vision as macula involved
Diplopia, scotoma, dimness in vision, photopsia, chest pain, headaches, nausea, shortness of breath, weakness
Is grade 1-3 symptomatic?
No
Which grades of hypertensive retinopathy are reversible?
Grade 1 and 2
What is hypertensive choriodopathy?
In grade 3-4 hypertensive retinopathy
Necrosis (death) of choriodal vessels causes choroidal ischameia (vessels die so no oxygen)
How can you detect hypertensive choriodopathy?
yellow spots in RPE
How can you detect CHRONIC hypertensive choriodopathy?
Yellow spots become pigmented clumps surrounded by atophic area
How do you manage hypertensive retinopathy depending on the grades?
Grade 1-2 refer to GP for BP check
Grade 3 refer to ophthalmologist
Grade 4 send to A&E. Unlikely to see this in practise as people regularly have BP checked
