Ocular manifestations of systemic disease: HTN

Question 1

Presentation of hypertensive retinopathy

Answer 1

Usually asymptomatic
Bilateral, symmetrical

Question 2

Early stages of hypertensive changes include

Answer 2

1. Diffuse/focal retinal arteriolar narrowing
2. Arteriolar wall opacification (silver/copper wiring)
3. Compression of the venules at the arteriovenous junction (AV nipping/nicking)

Question 3

What classification is used for hypertensive retinopathy?

Answer 3

Keith Wagener Barker

Question 4

Grade 1 of Keith-wagener-barker classification

Answer 4

Mild generalised arteriolar narrowing/sclerosis

Question 5

Grade 2 of Keith-wagener-barker classification

Answer 5

Generalised/focal arteriolar narrowing, silver/copper wiring, AV nicking/nipping
- Copper wiring: Progression of sclerosis and hyalinization causes the reflex to be more diffuse and the retinal arterioles to become red-brown
- Silver wiring: Retinal arterioles look white if they have become occluded 

Question 6

Grade 3 of Keith-wagener-barker classification

Answer 6

Grade 2 changes
+ Haemorrhages (dot/blot/flame), microaneurysms, cotton wool spots, hard exudates

Question 7

Grade 4 of Keith-wagener-barker classfication

Answer 7

Grade 3 changes
+ Optic disc swelling

Question 8

What additional fundoscopy sign can be seen in advanced hypertensive retinopathy?

Answer 8

Elschnig’s Spots
- choroidal infarcts

Question 9

Treatment of hypertensive retinopathy

Answer 9

Control underlying HTN!!!
Grade 3/4 are medical emergency!
- Treatment: IV Labetalol, rapidly bring down BP
- Death from AMI/ ICH more crucial than HTN retinopathy
Grade 1/2: Non-urgent referrals

Question 10

Other eye conditions associated with HTN

Answer 10

BRAO/ CRAO
BRVO/ CRVO
NAAION

Question 11

Fundoscopy findings in HTN retinopathy

Answer 11

Generalised/focal arteriolar narrowing
Silver/copper wiring
AV nicking/nipping
Haemorrhages (dot/bot/flame)
Cotton wool spots
Hard exudates
Optic disc swelling