Hypertensive

Retinopathy
Kazi Iftikhar Qureshi
Roll no 144
Group A5
Batch 2006-07
 Introduction
• Hypertension: Hypertension (HTN) or high blood
pressure is a chronic medical condition in which the
systemic arterial blood pressure is elevated.
• It is classified as either primary (essential) or secondary.
• Retinopathy: Retinopathy is a general term that
refers to some form of non-inflammatory damage to
the retina of the eye.
• Hypertensive Retinopathy: It is a condition
characterized by a spectrum of retinal
vascular signs in people with elevated blood
pressure.
 Historical Context
• Hypertensive retinopathy was first described
by Marcus Gunn in the 19th century in a series
of patients with hypertension and renal
disease.
• In 1939, Keith-Wegner & Berker classified
hypertensive changes in old(atherosclerotic)
individuals.
• In 1953, Scheie classified hypertensive
changes in young individuals WITHOUT
atherosclerotic changes.
 Path Physiology

I. Vasoconstriction

II. Increased
Vascular
Permeability

III. Atherosclerotic
changes.
 Clinical Features
• Symptoms:
1. Headache.
2. Loss of visual acuity may be sudden sometimes.
• Symptoms usually do not develop until late in the disease.
• Signs: Visible on fundus examination. Which are graded as
follow:
 Grade 1: Generalized arteriolar constriction - seen as `silver
wiring` and Vascular tortuosities.
 Grade 2: As grade 1 + irregularly located, tight constrictions
Known as `AV nicking` or `AV Nipping`.
 Grade 3: As grade 2 + with cotton wool spots and flame
hemorrhages.
 Grade 4: As above but with swelling of the optic disk
(papillodema).
 Clinical Picture
• Mild Hypertension: • Moderate Hypertension:
1. AV nicking 1. Same as of mild HTN
2. Focal narrowing 2. Cotton-Wool spots
3. Copper Wiring. 3. Yellow hard exudates
 Clinical Picture Cont.
• Malignant
Hypertension:
1. Retinopathy shows
Bilateral
papilloedema.
2. Star shaped
macular lesions.
3. Flame
hemorrhages.
 Differential Diagnoses

• Diabetic Retinopathy
• Collagen Vascular Disease
• Anemia
• Radiation Retinopathy
• Central Retinal Vein Occlusion
 Treatment
• A major aim of treatment is to prevent, limit,
or reverse such target organ damage by
lowering the patient's high blood pressure.
• Anti-hypertensive treatment plays a major
role in reversing the retinal changes.
• If vision loss occurs, treatment of the retinal
edema with laser or with intravitreal injection
of corticosteroids or anti-vascular endothelial
growth factor (VEGF) drugs may be useful.
 Complications
• Complications associated with high blood
pressure.
• Irreversible damage to the optic nerve or
macula, resulting in vision problems.

Conclusion
Hypertensive retinopathy is directly related to
systemic hypertension. If hypertension is left
untreated then signs of retinopathy start to show
on fundoscopy.
Thank You