Hypertensive retinopathy
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| Hypertensive retinopathy Classification and external resources | |
| ICD-10 | H35.0 |
|---|---|
| ICD-9 | 362.11 |
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Hypertensive retinopathy is damage to the retina due to high blood pressure (i.e. hypertension).
Pathophysiology
The retina is one of the "target organs" that are damaged by sustained hypertension. Subjected to excessively high blood pressure over prolonged time, the small blood vessels that involve the eye are damaged, thickening, bulging and leaking.
Early signs of retinopathy correlate less well with mortality and morbidity than used to be thought, but signs of accelerated or "malignant" hypertension indicate severe illness.
Symptoms
Most patients with hypertensive retinopathy present without visual symptoms, however, some may report decreased vision or headaches.
Signs
Signs of damage to the retina caused by hypertension include:
- Arteriosclerotic changes
- Arteriolar narrowing that is almost always bilateral
- Grade I - 3/4 normal caliber
- Grade II - 1/2 normal caliber
- Grade III - 1/3 normal caliber
- Grade IV - thread-like or invisible
- Arterio-venous crossing changes (aka "AV nicking") with venous constriction and banking
- Arteriolar color changes
- Copper wire arterioles are those arterioles in which the central light reflex occupies most of the width.
- Silver wire arterioles are those in which the central light reflex occupies all of the width of the arteriole.
- Vessel sclerosis
- Arteriolar narrowing that is almost always bilateral
- Ischemic changes (e.g. "cotton wool spots")
- Hemorrhages, often flame shaped.
- Edema
- Papilledema, or optic disc edema, in patients with malignant hypertension
- Visual acuity loss, typically due to macular involvement
Diagnosis
Treatment and management
A major aim of treatment is to prevent, limit, or reverse such target organ damage by lowering the patient's high blood pressure. The eye is an organ where damage is easily visible at an early stage, so regular eye examinations are important.
See also
- Hypertensive crisis
- List of eye diseases and disorders
- List of systemic diseases with ocular manifestations
- Ophthalmology
- Optometry
References
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease, J.B. Lippincott, 1994.
- Hypertensive retinopathy
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
