Hypertensive retinopathy
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Transcript of Hypertensive retinopathy
Hypertensive Retinopathy
Nabilah Ayob060100814Group H4
Definition
• What is Hypertensive Retinopathy?• Hypertensive retinopathy is retinal vascular
damage caused by hypertension.
Pathophysiology
Systermic chronic
hypertension
Arteriosclerosis and
atherosclerosis predominates
Narrowing of retinal arterioles
Retinal Ischaemia Hypoxia
Increased capillary
permeability
Focal Retinal Oedema, retinal haemorrhage,cotton wool spots, hard
exudates
Clinical Manifestation• Most patients are asymptomatic. • Some present with headaches and blurred vision.• On ophthalmoscopy :
– Generalized arteriolar narrowing– Changes of the arterovenous crossings– Flame haemorrhage– Microaneurysms– Exudates– Arteriolar macroaneurysms– Cotton-wool spots– Optic disc swelling– FIPT ( Focal Intraretinal Periarteriolar Transudates)
Classification• Keith-Wagener-Barker classification
Grade DescriptionGrade 1 Slight narrowing, sclerosis, and tortuosity of the retinal arterioles; mild,
asymptomatic hypertensionGrade 2 Definite narrowing, focal constriction, sclerosis, and AV nicking; blood
pressure is higher and sustained; few, if any, symptoms referable to blood pressure
Grade 3 Retinopathy (cotton-wool patches, arteriolosclerosis, hemorrhages); blood pressure is higher and more sustained; headaches, vertigo, and nervousness; mild impairment of cardiac, cerebral, and renal function
Grade 4 Neuroretinal edema, including papilledema; Siegrist streaks, Elschnig spots; blood pressure persistently elevated; headaches, asthenia, loss of weight,
dyspnea, and visual disturbances; impairment of cardiac, cerebral, and renal function
• Scheie classification
Staging under this system is as follows:
Stage 0 - Diagnosis of hypertension but no visible retinal abnormalities
Stage 1 - Diffuse arteriolar narrowing; no focal constriction
Stage 2 - More pronounced arteriolar narrowing with focal constriction
Stage 3 - Focal and diffuse narrowing, with retinal hemorrhage
Stage 4 - Retinal edema, hard exudates, optic disc edema
The Scheie classification also grades the light reflex changes from arteriolosclerotic changes, as follows :Grade 0 - Normal
Grade 1 - Broadening of light reflex with minimal arteriolovenous compression
Grade 2 - Light reflex changes and crossing changes more prominent
Grade 3 - Copper-wire appearance; more prominent arteriolovenous compressionGrade 4 - Silver-wire appearance; severe arteriolovenous crossing changes
Modified Scheie classification
Grade 0 - No changes
Grade 1 - Barely detectable arterial narrowing
Grade 2 - Obvious arterial narrowing with focal irregularities
Grade 3 - Grade 2 plus retinal hemorrhages and/or exudates
Grade 4 - Grade 3 plus disc swelling
Diagnosis• Diagnosis is made by
thorough history of the patient, ophthalmoscopy (direct or indirect) and also physical examination.
• History – May reveal decrease of
patient vision, occipital headache and high blood pressure.
• Physical examination– May detect elevation of
blood pressure
• Ophthalmoscopy– Show changes in arteriovenous
crossings– Cotton-wool spot– Flame haemorrhage– Silver wire appearance of
narrowed arterioles– Nicking of veins where arteries
cross them (arteriovenous nicking)
– Hard exudates “lipids deposites”– “Macular star”– Flame shape haemorrhage– Retinal oedema– Swelling of the optic nerve– Aterial microaneurysms– Arteriolar macroaneurysms
Differential Diagnosis
• Diabetic retinopathy
• Collagen vascular diseases
Management
• A major aim of treatment is to prevent, limit, or reverse such target organ damage by lowering the patient's high blood pressure.
• Lifestyle changes Promote Healthy lifestyle; exercise, healthy foods
• Advice patient to reduce the Blood Pressure – Taking the medication accordingly– Referral to medical team
Complications
• Complications of hypertensive retinopathy include:
• Blindness• Reduce in vision