hypertension and ocular changes

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Post on 25-Jun-2015

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hypertensive retinopathy, ghtn ocular changes, hypertensive choroidopathy, clinical features, pathognomonic signs, management

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  • 1. A.R. Shaan House Surgeon S1 Unit

2. Hypertensive retinopathyHypertensive optic neuropathyHypertensive choroidopathy 3. Fundus changes in systemic hypertension first described by Liebreich in 1859. Marcus Gunn described the changes in retinal vessels noted with hypertension - 1898 4. VasoconstrictionArteriosclerosisIncreased vascular permeability 5. Grade I Mild generalised arteriolar attenuation Broadening of arteriolar light reflex Vein concealment 6. Grade II Marked generalised narrowing and focal attenuation of artertioles Salus Sign (deflection of veins at AV crossings) 7. 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 exudatesGunn SignBonnet sign 8. Grade IV Grade III charges Silver wiring of arterioles Papilloedema 9. Hypertension with senile sclerosisHypertension without sclerosisHypertension with compensatory sclerosisMalignant hypertension 10. Hypertension with senile sclerosis Elderly ( >50) Fundus : augmented arteriosclerotic retinopathy 11. Hypertension without sclerosis Young Exposure to raised blood pressure for a short duration No retinal signs No papilloedema/exudates 12. Hypertension with compensatory arteriolar sclerosis Young Prolonged bening hypertension Proliferative & fibrous changes mediaalbiminuric / renal retinopathy 13. Malignant Hypertension Marked arteriolar narrowingPapilloedema Retinal edema over posterior pole Superficial flame shaped hemorrhages Abundance of cotton wool patches 14. BP >160/100mm Hg> 200/130mm HgNarrowing of nasal arterioles-generalisedCotton wool spots; retinal hemmorhagesretinal hypoxia Macular star flat macular detachment 15. 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. 16. choroidal ischaemia choroidal vascular sclerosisElschnig spotsrepresenting focal areas of degenerative retinal pigment epithelium 17. Prompt control of BP Grade IV retinopathy/ Papilloedema: matter of urgent referral

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