Hypertensive Retinopathy

Question 1

What are some ocular complications of raised BP?

Answer 1

Cranial nerve palsies

Sub-conjunctival haemorrhages

Hypertensive retinopathy

Question 2

What are the signs of Grade 1 Hypertensive Retinopathy?

Answer 2

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
- Normal A/V ratio
reduced

Increased venous
tortuosity may also be
seen

Optometric
management: Refer
to GP if not already
being treated

Question 3

What are the signs of Grade 2 Hypertensive Retinopathy?

Answer 3

Moderate to marked
narrowing of the
arterioles
- Local and or generalised

Arteriovenous crossing
changes

Increase in the light reflex

Nipping/Gunn’s sign

Copper wire

Optometric
management: Refer
to GP if not already
being treated

Question 4

What is Nipping!/Gunn’s sign?

Answer 4

Thinning of venuole at an
arteriole crossing

Classic sign of systemic
hypertension

May persist even if hypertension
under control

Question 5

What is ‘Copper Wire’?

Answer 5

Increase in elastic and muscular
components of artery wall

Hypertensive arteriosclerosis –
increased light reflex

Question 6

What are the signs of Grade 3 Hypertensive Retinopathy?

Answer 6

Typically BP Dystolic
110-115mmHg

Grade 2 arterial
narrowing and focal
constriction plus the
following:
• Cotton wool spots

• Retinal haemorrhages - Flame shaped
haemorrhages that are:

                                              - Superficial
                                              - Follow the path of the nerve fibre layer 

• Hard exudates - Lipo-proteins
• Retinal oedema - Chronic macular
  oedema may result in
  hard exudates
  deposited around the
  fovea = macular star

Optometric
management:
Rapid referral to GP
for cardiovascular
check

Question 7

What are the signs of Grade 4 Hypertensive Retinopathy?

Answer 7

Occurs in malignant
hypertension i.e.
Diastolic
130-140mmHg

All features of Grade
3 plus:
Optic disc swelling
Reduced VA
Headache

Optometric Management :
Refer to A&E
Risk of ocular, cardiac, renal and cerebral damage