HYPERTENSION & OCULAR CHANGES

A.R. ShaanHouse

SurgeonS1 Unit

Hypertensive retinopathy

Hypertensive optic neuropathy

Hypertensive choroidopathy

OCULAR MANIFESTATIONS

Fundus changes in systemic hypertension

first described by Liebreich in 1859.

Marcus Gunn described the changes in retinal vessels noted with hypertension - 1898

HYPERTENSIVE RETINOPATHY

Vasoconstriction

Arteriosclerosis

Increased vascular permeability

Pathogenesis

Grade I

Mild generalised arteriolar attenuation

Broadening of arteriolar light reflex

Vein concealment

Grading ( Keith & Wegner)

Grade II

Marked generalised narrowing and focal attenuation of artertioles

Salus’ Sign (deflection of veins at AV crossings)

Grade III

Grade II changes

Copper wiring of arterioles

Bonnet Sign (banking of veins distal to av crossings)

Gunn Sign (tapering of vein on either side of av crossings)

Flame shaped haemorrhages,

Cotton wool spots Hard exudates

Gunn Sign Bonnet sign

Grade IV

Grade III charges

Silver wiring of arterioles

Papilloedema

Hypertension with senile sclerosis

Hypertension without sclerosis

Hypertension with compensatory sclerosis

Malignant hypertension

CLINICAL SUBTYPES

Hypertension with senile sclerosis

Elderly ( >50) Fundus : augmented arteriosclerotic retinopathy

Hypertension without sclerosis

Young Exposure to raised blood pressure for a short

duration No retinal signs No papilloedema/exudates

Hypertension with compensatory arteriolar sclerosis

Young Prolonged bening hypertension Proliferative & fibrous changes media “albiminuric / renal retinopathy”

Malignant Hypertension

Marked arteriolar narrowing Papilloedema Retinal edema over posterior pole Superficial flame shaped hemorrhages Abundance of cotton wool patches

BP >160/100mm Hg- > 200/130mm Hg

Narrowing of nasal arterioles-generalised

Cotton wool spots; retinal hemmorhages- retinal hypoxia

‘Macular star’ – ‘flat macular detachment’

Retinopathy in PIH

Papilloedema or bilateral disc swelling

Papilloedema secondary to hypertension usually resolve following good control of blood pressure although some developed disc pallor

Longstanding chronic hypertension may result in retinal nerve fibre loss.

HYPERTENSIVE OPTIC NEUROPATHY

choroidal ischaemia

choroidal vascular sclerosis

Elschnig spots representing focal areas of degenerative retinal pigment epithelium

HYPERTENSIVE CHOROIDOPATHY

Prompt control of BP

Grade IV retinopathy/ Papilloedema: matter of urgent referral

Management

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