Hypertensive Retinopathy

Nabilah Ayob060100814Group H4

Definition

• What is Hypertensive Retinopathy?• Hypertensive retinopathy is retinal vascular

damage caused by hypertension.

Pathophysiology

Systermic chronic

hypertension

Arteriosclerosis and

atherosclerosis predominates

Narrowing of retinal arterioles

Retinal Ischaemia Hypoxia

Increased capillary

permeability

Focal Retinal Oedema, retinal haemorrhage,cotton wool spots, hard

exudates

Clinical Manifestation• Most patients are asymptomatic. • Some present with headaches and blurred vision.• On ophthalmoscopy :

– Generalized arteriolar narrowing– Changes of the arterovenous crossings– Flame haemorrhage– Microaneurysms– Exudates– Arteriolar macroaneurysms– Cotton-wool spots– Optic disc swelling– FIPT ( Focal Intraretinal Periarteriolar Transudates)

Classification• Keith-Wagener-Barker classification

Grade DescriptionGrade 1 Slight narrowing, sclerosis, and tortuosity of the retinal arterioles; mild,

asymptomatic hypertensionGrade 2 Definite narrowing, focal constriction, sclerosis, and AV nicking; blood

pressure is higher and sustained; few, if any, symptoms referable to blood pressure

Grade 3 Retinopathy (cotton-wool patches, arteriolosclerosis, hemorrhages); blood pressure is higher and more sustained; headaches, vertigo, and nervousness; mild impairment of cardiac, cerebral, and renal function

Grade 4 Neuroretinal edema, including papilledema; Siegrist streaks, Elschnig spots; blood pressure persistently elevated; headaches, asthenia, loss of weight,

dyspnea, and visual disturbances; impairment of cardiac, cerebral, and renal function

• Scheie classification

Staging under this system is as follows:

Stage 0 - Diagnosis of hypertension but no visible retinal abnormalities

Stage 1 - Diffuse arteriolar narrowing; no focal constriction

Stage 2 - More pronounced arteriolar narrowing with focal constriction

Stage 3 - Focal and diffuse narrowing, with retinal hemorrhage

Stage 4 - Retinal edema, hard exudates, optic disc edema

The Scheie classification also grades the light reflex changes from arteriolosclerotic changes, as follows :Grade 0 - Normal

Grade 1 - Broadening of light reflex with minimal arteriolovenous compression

Grade 2 - Light reflex changes and crossing changes more prominent

Grade 3 - Copper-wire appearance; more prominent arteriolovenous compressionGrade 4 - Silver-wire appearance; severe arteriolovenous crossing changes

Modified Scheie classification

Grade 0 - No changes

Grade 1 - Barely detectable arterial narrowing

Grade 2 - Obvious arterial narrowing with focal irregularities

Grade 3 - Grade 2 plus retinal hemorrhages and/or exudates

Grade 4 - Grade 3 plus disc swelling

Diagnosis• Diagnosis is made by

thorough history of the patient, ophthalmoscopy (direct or indirect) and also physical examination.

• History – May reveal decrease of

patient vision, occipital headache and high blood pressure.

• Physical examination– May detect elevation of

blood pressure

• Ophthalmoscopy– Show changes in arteriovenous

crossings– Cotton-wool spot– Flame haemorrhage– Silver wire appearance of

narrowed arterioles– Nicking of veins where arteries

cross them (arteriovenous nicking)

– Hard exudates “lipids deposites”– “Macular star”– Flame shape haemorrhage– Retinal oedema– Swelling of the optic nerve– Aterial microaneurysms– Arteriolar macroaneurysms

Differential Diagnosis

• Diabetic retinopathy

• Collagen vascular diseases

Management

• A major aim of treatment is to prevent, limit, or reverse such target organ damage by lowering the patient's high blood pressure.

• Lifestyle changes Promote Healthy lifestyle; exercise, healthy foods

• Advice patient to reduce the Blood Pressure – Taking the medication accordingly– Referral to medical team

Complications

• Complications of hypertensive retinopathy include:

• Blindness• Reduce in vision