Updated: 7/22/2019

Hypertensive Retinopathy

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Snapshot
  • A 58-year-old man is referred to his ophthalmologist for progressive visual loss. Medical history is remarkable for essential hypertension, which he has been nonadherent to antihypertensive medication, lisinopril. His systolic blood pressures have been in the 160s for the past 6 years. Slit-lamp examination is notable for arterial narrowing, arteriovenous nicking, and silver wiring.
Introduction
  • Overview
    • an ocular manifestation of hypertension
  • Epidemiology
    • incidence
      • the most common ocular presentation of hypertension
    • risk factors
      • hypertension
      • high salt diet
      • obesity
      • tobacco use
      • alcohol use
      • family history
  • Pathophysiology
    • hypertension damages the retinal vasculature
      • acute increases in blood pressure causes reversible retinal blood vessel vasoconstriction
      • chronic blood pressure leads to endothelial damage, leading to exudative vascular changes
  • Prognosis
    • patients are at increased risk for
      • retinal artery occlusion
      • retinal vein occlusion
      • retinal macroaneurysms
Presentation
  • Symptoms
    • decreased visual acuity
  • Physical exam
    • acute hypertension
      • flame-shaped hemorrhage
      • cotton-wool spots
        • represents foci of retinal ischemia
      • yellow hard exudates
      • optic disc edema
    • chronic hypertension
      • arterial narrowing
      • arteriovenous nicking
      • copper and silver wiring
Studies
  • Clinical diagnosis
Differential
  • Diabetic retinopathy
    • differentiating factor
      • poorly controlled diabetes
Treatment
  • Medical
    • antihypertensive therapy
      • indication
        • first-line treatment
Complications
  • Irreversible retinal damage in chronic untreated hypertension
 

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