eye disorders
Hypertensive Retinopathy
Symptoms and Signs of Hypertensive Retinopathy
Symptoms usually do not develop until late in the disease and include blurred vision or visual field defects. In the early stages, funduscopy identifies arteriolar constriction, with a decrease in the ratio of the width of the retinal arterioles to the retinal venules. Chronic, poorly controlled hypertension causes the following: Permanent arterial narrowing Arteriovenous crossing abnormalities (arteriovenous nicking) Arteriosclerosis with moderate vascular wall changes (copperwiring) to more severe vascular wall hyperplasia and thickening (silver wiring) Sometimes total vascular occlusion occurs. Arteriovenous nicking is a major predisposing factor to the development of a branch retinal vein occlusion. If acute disease is severe, the following can develop: Superficial flame-shaped hemorrhages Small, white, superficial foci of retinal ischemia (cotton-wool spots) Yellow hard exudates Optic disk edema Moderate hypertensive retinopathy is characterized by thinned, straight arteries, intraretinal hemorrhages, and yellow hard exudates. RALPH C. EAGLE, JR./SCIENCE PHOTO LIBRARY This image shows retinal arteriolar narrowing due to thickening and opacification of arteriolar walls (copper wiring) caused by hypertensive arteriosclerosis. © Springer Science+Business Media The cardinal funduscopic feature of malignant hypertension is optic disk swelling, which appears as blurring and elevation of disk margins. The image also shows a characteristic star-shaped macular lesion caused by leaking retinal vessels. © Springer Science+Business Media Yellow hard exudates represent intraretinal lipid deposition from leaking retinal vessels. These exudates can develop a star shape within the macula, particularly when hypertension is severe. In severe hypertension, the optic disk becomes congested and edematous (papilledema indicating Hypertensive Emergencies ). 