Hypertensive retinopathy

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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202 Hypertensive retinopathy

Instruction

Examine this patient’s eyes.

Examine this patient’s fundus.

Salient features

History

• Usually no ocular symptoms

• History of hypertension.

Examination

• Arteriovenous nipping (Fig. 202.1)

• Arteriolar narrowing

• Macular star

• Flame-shaped and blot haemorrhages (see Fig. 201.3B)

• Cottonwool exudates (see Fig. 201.3D)

• Papilloedema may or may not be present (Fig. 202.2).

Fig. 202.1 (A) Mild retinopathy in an eye with ischaemic optic neuropathy. (B) Severe hypertensive retinopathy. CWS, cotton-wool spots; FH, flame-shaped retina haemorrhage; DS, swelling of the optic disc; AVN, arteriovenous nipping.

(With permission from Wong, Mitchell 2007.)

Fig. 202.2 (A) Grade 1: early and minor changes include increased tortuosity of a retinal vessel and increased reflectiveness (silver wiring) of a retinal artery (at 1 o’clock in this view). (B) Grade 2: increased tortuosity and silver wiring (arrowheads) plus ‘nipping’ of the venules at arteriovenous crossings (arrow). (C) Grade 3: as grade 2 plus flame-shaped retinal haemorrhages and soft ‘cotton-wool’ exudates. (D) Grade 4: swelling of the optic disc (papilloedema), retinal oedema and hard exudates around the fovea, producing a typical ‘macular star’.

(With permission from Forbes, Jackson 2003.)

Proceed as follows:

• Tell the examiner that you would like to:

• check the BP

• examine the urine for proteinuria

• examine the heart for left ventricular hypertrophy.

Diagnosis

This patient has flame-shaped haemorrhages with a macular star (lesions) caused by hypertension (aetiology).

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