Hypertensive Retinopathy

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Hypertensive Retinopathy refers to retinal changes that occur as a result of uncontrolled Hypertension. It occurs due to vasospasm of vessels following raised blood pressure.

Nearly 26% of the adult population worldwide is affected by Hypertension. Recent studies declared that the prevalence of Hypertension in 2000 was 26% of the adult population globally and that in 2025 the prevalence would increase by 24% in developed countries and 80% in developing countries.

Hypertensive Retinopathy is a clinical condition of retinal microvascular damage from elevated blood pressure. Hypertensive Retinopathy is associated with cardiovascular morbidity and mortality. Hence, the prevalence and spectrum of hypertensive Retinopathy in the population reflect the status of Hypertension control and of the associated risks for cardiovascular events.

There are various classifications for Hypertensive Retinopathy; however, the most commonly used one is Keith Wagner’s classification of Hypertensive Retinopathy:

Grade 1: Minimal constriction of arterioles with some tortuosity.

Grade 2: Findings in group 1 with definite focal narrowing and arteriovenous nicking.

Grade 3: Above findings with Hemorrhages, exudates, and cotton wool spots.

Grade 4: All the above, along with optic disc oedema.

The different phases of Hypertensive Retinopathy are:

  • Vasoconstrictive phase
  • Exudative phase
  • Sclerotic phase

The changes seen in the vasoconstrictive phase are diffuse and focal arteriolar narrowing and reduction in arteriole to venule ratio. The exudative phase consists of flame-shaped haemorrhages, cotton wool spots and hard exudates.

The sclerotic phase is characterised by sclerosis of vessels and AV crossing changes.

Symptoms

The patient is most often asymptomatic; however, symptoms of defective vision will be present in a later stage when the fundus changes, such as optic disc oedema and macular oedema sets in.

Complications

Malignant Hypertension

When the diastolic blood pressure is more than 140mmHg, it results in fibrinoid necrosis of the arterioles, choroidopathy and optic neuropathy, which are severe complications resulting in a permanent reduction in vision.

Ocular manifestations in pregnancy-induced Hypertension

These are divided into Conjunctival findings-

  • Capillary tortuosity
  • Conjunctival haemorrhages
  • Ischemic necrosis of conjunctiva

Hypertensive Retinopathy changes include,

  • Choroid-serous detachments
  • Optic nerve-disc oedema, optic atrophy in few patients.

Management of pregnancy-induced Hypertension includes,

The fundus changes in pregnancy-induced Hypertension come back to normal in response to appropriate medical therapy or after delivery.

Management of Hypertensive Retinopathy

The strict control of Hypertension is the key to the management of hypertensive Retinopathy.

Conclusion

An ophthalmologist mainly plays a supportive role to a primary care physician in the diagnosis and management of systemic Hypertension with a prompt referral.


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