Hypertensive retinopathy is damage to the retina and retinal circulation due to high blood pressure (i.e. hypertension).

Signs and symptoms

Most patients with hypertensive retinopathy have no symptoms. However, some may report decreased or blurred vision, and headaches.

Signs

Signs of damage to the retina caused by hypertension include: Doppler laser imaging of the papilla of a patient with hypertension

* Arteriolar changes, such as generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, changes in the arteriolar wall (arteriosclerosis) and abnormalities at points where arterioles and venules cross. Manifestations of these changes include ''Copper wire arterioles'' where the

central light reflex Central is an adjective usually referring to being in the center of some place or (mathematical) object. Central may also refer to: Directions and generalised locations * Central Africa, a region in the centre of Africa continent, also known as ...

occupies most of the width of the arteriole and ''Silver wire arterioles'' where the central light reflex occupies all of the width of the arteriole, and "arterio-venular (AV) nicking" or "AV nipping", due to venous constriction and banking. * advanced retinopathy lesions, such as microaneurysms, blot hemorrhages and/or flame hemorrhages,

ischemic Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems wi ...

changes (e.g. "

cotton wool spots Cotton wool spots are opaque fluffy white patches on the retina of the eye that are considered an abnormal finding during a funduscopic exam (also called an ophthalmoscopic exam). Cotton wool spots are typically a sign of another disease state, mo ...

"), hard exudates and in severe cases swelling of the optic disc ( optic disc edema), a ring of exudates around the retina called a "

macula The macula (/ˈmakjʊlə/) or macula lutea is an oval-shaped pigmented area in the center of the retina of the human eye and in other animals. The macula in humans has a diameter of around and is subdivided into the umbo, foveola, foveal avas ...

r star" and visual acuity loss, typically due to macular involvement. * Strongly modulated blood flow pulse in central and branch arteries can result from hypertension.

Microangiography Microangiography ( ) is a type of angiography that consists of the radiography of small blood or lymphatic vessels of an organ. While most other types of angiography cannot produce images of vessels smaller than 200 µm in diameter, microang ...

by laser Doppler imaging may reveal altered hemodynamics non-invasively. Mild signs of hypertensive retinopathy can be seen quite frequently in normal people (3–14% of adult individuals aged ≥40 years), even without hypertension. Hypertensive retinopathy is commonly considered a diagnostic feature of a hypertensive emergency although it is not invariably present.

Pathophysiology

The changes in hypertensive retinopathy result from damage and adaptive changes in the arterial and arteriolar circulation in response to the high blood pressure.

Diagnosis

Fundoscopy and patients history.

Differential Diagnoses

Several other diseases can result in retinopathy that can be confused with hypertensive retinopathy. These include diabetic retinopathy, retinopathy due to

autoimmune disease An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. At least 80 types of autoimmune diseases have been identified, with some evidence suggesting that there may be more than 100 types. Nearly a ...

anemia Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, t ...

radiation retinopathy Radiation retinopathy is damage to retina due to exposure to ionizing radiation. Radiation retinopathy has a delayed onset, typically after months or years of radiation, and is slowly progressive. In general, radiation retinopathy is seen around 1 ...

, and

central retinal vein occlusion Central retinal vein occlusion, also CRVO, is when the central retinal vein becomes occluded, usually through thrombosis. The central retinal vein is the venous equivalent of the central retinal artery and both may become occluded. Since the centra ...

Keith Wagener Barker (KWB) Grades

;Grade 1 :Vascular Attenuation ;Grade 2 :As grade 1 + Irregularly located, tight constrictions – Known as "AV nicking" or "AV nipping" –

Salus's sign Salus's sign is a clinical sign in which deflection of retinal venules can be seen on fundoscopy occurring in patients with hypertensive retinopathy. Arteriosclerosis causes shortening or lengthening of arteriole An arteriole is a small-diameter ...

;Grade 3 :As grade 2 + Retinal edema, cotton wool spots and flame-hemorrhages "Copper Wiring" + Bonnet's Sign + Gunn's Sign ;Grade 4 :As grade 3 + optic disc edema + macular star "Silver Wiring" There is an association between the grade of retinopathy and mortality. In a classic study in 1939 Keith and colleaguesKeith NM, Wagener HP, Barker NW (1939) Some different types of essential hypertension: their course and prognosis. Am J Med Sci, 197, 332–43. described the prognosis of people with differing severity of retinopathy. They showed 70% of those with grade 1 retinopathy were alive after 3 years whereas only 6% of those with grade 4 survived. The most widely used modern classification system bears their name. The role of retinopathy grading in risk stratification is debated, but it has been proposed that individuals with signs of hypertensive retinopathy signs, especially retinal hemorrhages, microaneurysms and cotton-wool spots, should be assessed carefully.

Management

A major aim of treatment is to prevent, limit, or reverse target organ damage by lowering the person's high blood pressure to reduce the risk of cardiovascular disease and death. Treatment with antihypertensive medications may be required to control the high blood pressure.

References

External links

{{DEFAULTSORT:Hypertensive Retinopathy Disorders of choroid and retina