Date post: | 25-Jun-2015 |
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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
Thank you