analyse_media
Here is a clean, structured summary of all content from your notes on Hypertensive Retinopathy:
Hypertensive Retinopathy
Definition: Fundus changes occurring in patients suffering from systemic hypertension.
Pathogenesis (3 Factors)
-
Vasoconstriction of retinal arterioles & choroidal vessels
- Choroidal & RPE ischaemia → hypertensive choroidopathy
- Vasoconstriction of peripapillary choroid → optic nerve head ischaemia → hypertensive optic neuropathy
-
Arteriosclerotic changes in the vessels
-
Increased vascular permeability (due to hypoxia)
- Responsible for haemorrhages, exudates, focal retinal oedema, macular oedema, etc.
Clinical Types
| Type | Clinical Features |
|---|---|
| 1) Simple hypertension without sclerosis | Seen in young patients with elastic arterioles; generalized arteriolar constriction; superficial flame-shaped haemorrhages & cotton wool exudates may be present |
| 2) Hypertension with involutionary (senile) sclerosis | Seen in elderly (>50 yrs); AV crossing changes are diagnostic (Gunn's sign, Bonnet sign, Salus' sign); hard exudates deposited; retinal haemorrhages without oedema |
| 3) Chronic hypertension with compensatory arteriolar sclerosis | Young patients; associated with chronic glomerulonephritis - called "albuminuric" or "renal" retinopathy; narrow tortuous vessels with AV nicking; multiple haemorrhages with oedema; cotton wool exudates (early) + hard exudates (later); vision seriously impaired |
| 4) Malignant (acute) hypertensive retinopathy | Marked arteriolar narrowing + generalised oedema/exudates → papilloedema, disc pallor, macular star, flame-shaped haemorrhages; FIPTs (Focal Intraretinal Periarteriolar Transudates - from breakdown of blood-retinal barrier); Elschnig's spots (focal white spots); Siegrist streaks (fibrinoid necrosis); cotton wool spots; associated with renal insufficiency; visual prognosis grave unless controlled |
Keith & Wegner Grading
| Grade | Fundus Findings |
|---|---|
| Grade 1 | Mild arteriolar attenuation (small branches) + broadening of arteriolar light reflex |
| Grade 2 | Marked arteriolar attenuation + deflection of veins at AV crossings (Salus' sign) |
| Grade 3 | Grade 2 + Copper wiring of arterioles; Bonnet sign (banking of veins distal to AV crossings); Gunn sign (tapering of veins on either side of crossings); flame-shaped haemorrhages, cotton-wool spots, hard exudates |
| Grade 4 | Grade 3 + Silver wiring of arterioles + papilloedema |
Key AV Crossing Signs (Memory Aid)
- Salus' sign - deflection (bending) of vein at crossing (Grade 2)
- Gunn sign - tapering of veins on either side of crossing (Grade 3)
- Bonnet sign - banking (damming) of veins distal to crossing (Grade 3)
Management
- Mild cases: BP control only
- Moderate cases (haemorrhages, microaneurysms, cotton-wool spots): BP control + risk reduction therapy (e.g., cholesterol-lowering agents)
- Accelerated hypertensive retinopathy (bilateral disc swelling + severe HTN): Stepwise BP reduction over a few hours - avoid a sudden BP drop, which can reduce perfusion to the optic nerve head and CNS (risk of stroke)
Exam tip: Grade 3 is the most clinically busy grade - it has copper wiring + all three AV crossing signs + haemorrhages/exudates. Grade 4 adds silver wiring and papilloedema.
This is a shared conversation. Sign in to Orris to start your own chat.