Hypertensive retinopathy

Pathophysiology

Systemic hypertension can either be chronic hypertension or it may be acutely raised as in malignant hypertension. This high pressure damages the small vessels in the eye through arteriolar vasoconstriction and leakage.

😷 Presentation

There are a couple of important signs that we need to identify on fundoscopy:

• Silver wiring - sclerosis of arterioles leads to increased reflection of light and an appearance that a silver wire is running through the arterioles.
• AV nicking - arterioles cause compression of veins where they cross leading to a smaller region at the point of crossing accompanied by a bulge on either side of the crossing.
• Hard exudates- lipid leakage into the retina due to damaged vessels.
• Retinal haemorrhages - due to rupture of vessels.
• Cotton wool spots - due to damage of nerve fibres.
• Papilloedema - due to ischaemia to optic nerve → swelling of the optic nerve and blurring of optic disk margins.

🔢 Classification

We can classify it using the Keith-Wagner classification for hypertensive retinopathy which divides it from stage I - IV: