Hypertensive Retinopathy

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Hypertensive Retinopathy : 

Hypertensive Retinopathy Dr Gyanendra Lamichhane Dr.R.N.Byanju Dr.I.Kansakar Lumbini Eye Institute, Bhairahawa

Introduction: : 

Introduction: incidence of Hypertensive Retinopathy: 15% of HTN population primary response of the retinal arterioles to systemic hypertension is narrowing narrowing -dependent on pre-existing replacement fibrosis / sclerosis of arterioles HTN Retinopathy is characterized by : Vasoconstriction Leakage Arteriolosclerosis

Vasoconstriction: : 

Vasoconstriction: generalized & focal arteriolar narrowing obstruction of precapillary arterioles cotton-wool spots

Leakage: : 

Leakage: caused by abnormal vascular permeability flame-shaped haemorrhage hard exudates retinal oedema swelling of the optic nerve head macular star configuration

Arteriolosclerosis: : 

Arteriolosclerosis: thickening of the vessel wall: intimal hyalinization medial hypertrophy endothelial hyperplasia changes at arteriovenous crossing (AV Nipping)

Grading of Retinal Arteriolosclerosis: : 

Grading of Retinal Arteriolosclerosis:

Grading of HTN Retinopathy: : 

Grading of HTN Retinopathy: Grade 1: mild generalized arteriolar attenuation broadening of the arteriolar light reflex vein concealment Grade 2: more severe, generalized & focal arteriolar attenuation deflection of veins atarteriovenous crossings(Salus’ Sign)

Grading of HTN Retinopathy:… : 

Grade 3: copper-wiring of arterioles banking of veins distal to arteriovenous crossings (Bonnet Sign) tapering of veins on either side of the crossings (Gunn Sign) right-angled deflection of veins flame-shaped haemorrhages cotton-wool spots hard exudates Grading of HTN Retinopathy:…

Grading of HTN Retinopathy:… : 

Grade 4: all grade 3 changes silver-wiring of arterioles optic disc swelling Grading of HTN Retinopathy:…

Other Ocular Manifestations of HTN: : 

Other Ocular Manifestations of HTN: BRVO RAO Ischaemic Choroidal Infarcts(Elschnig Spots) Retinal Artery Macroaneurysm AION Ocular motor nerve palsies RD Worsening of DM Retinopathy

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