Hypertensive Choroidopathy

Hypertensive choroidopathy is less well recognized compared with

hypertensive retinopathy. The underlying mechanism of
hypertensive choroidopathy is related to choroidal ischemia which
has effects on the retinal pigment epithelium and retina. Like the
retinal vessels, the choroidal vessels may also undergo fibrinoid
necrosis at the level of the choroidal capillaries in the presence of
elevated blood pressure, leading to hypertensive choroidopathy
signs that include Elschnig spots (round, deep, and gray–yellow
patches at the level of the retinal pigment epithelium) and Siegrist
streaks (linear hyperpigmented streaks along choroidal arteries). In
severe cases, there may also be serous retinal detachment which can
lead to vision loss.92–94

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Hypertensive Choroidopathy
Hypertensive choroidopathy typically occurs in young patients who experience an episode
of acute hypertension associated with preeclampsia, eclampsia, pheochromocytoma, or
renal hypertension. Lobular nonperfusion of the choriocapillaris may occur and initially
results in tan, lobule-sized patches that, in time, become hyperpigmented and surrounded
by margins ofhypopigmentation; these are known as Elschnig spots (Fig 6-2). Linear
configurations
of similar-appearing hyperpigmentations known as Siegrist streaks follow the
CHAPTER 6: Other Retinal Vascular Diseases • 115
Figure 6-2 Elschnig spots. !Courtesy of Harry W Flynn, Jr, MD.!
meridional course of choroidal arteries in patients with acute, uncontrolled hypertension.
Fluorescein angiography shows focal choroidal hypoperfusion in early phases and multiple
subretinal areas ofleakage in late phases (Fig 6-3). Focal retinal pigment epithelium
(RPE) detachments may occur, and extensive bilateralbilateral exudative retinal detachments
may
develop in severe cases on rare occasions.

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