Chronic Hypertensive Retinopathy: Pathogenesis and clinical findings
Risk Factors for 1° HTN (ex. 1` Age, FHx, Ethnicity, Diet, Smoking, 1` Alcohol use, Stress, 1` Salt intake, 1` BMI, 1, Exercise) • 1° HTN
Retinal Detachment
Vitreous Hemorrhage
Central/Branch Retinal Artery/Vein Occlusions
Risk Factors for 2° HTN (ex. Hyperaldosterone, Cushing’s, Acromegaly, Chronic Kidney Disease, Obstructive Sleep Apnea, Diabetes Mellitus, Hypo/Hyper-thyroid, Adrenal Hyperplasia, Renal Artery Stenosis)
2° HTN
Ophthalmic Artery Hypertension ,17
Stage 1: Mild/vasoconstrictive
Stage 2: Moderate/sclerotic
Stage 3: Severe/exudative
Stage 4: Malignant
Abbreviations: • HTN — Hypertension • BRB — Blood-retinal barrier • RPE — Retinal pigment epithelium
Legend:
Pathophysiology
Mechanism
Acute and chronic vasospasm

Authors: Graeme Prosperi-Porta Reviewers: Stephanie Cote Usama Malik Johnathan Wong* * MD at time of publication
Diffuse and focal arterial narrowing and vascular tortuosity
Atherosclerosis and hyalinization causes arteriolar wall thickening resulting in a diffuse light reflex appearing red-brown coloured
Thickening of the arteriolar wall and/or sclerotic thickening at the arteriole/venule crossing compresses the underlying venule
BRB breakdown causes dot/blot hemorrhages in the inner retina and flame hemorrhages in the nerve fiber layer
Serum proteins and lipids leakage from damaged BRB appears as white or yellow areas with sharp margins
Occlusion of the terminal retinal arterioles causes fluffy white ischemic lesions in the inner retinal nerve fiber layer
Hyper-pigmented patches surrounded by a hypo-pigmented ring due to RPE clumping around atrophic areas in the choroid
Sign/Symptom/Lab Finding
lschemia of optic disc arterioles causes optic nerve swelling and blurred disc margins. Leakage of optic disc arterioles causes hemorrhage and disc edema.
Complications
Copper Wiring
AV nicking
Retinal Hemorrhages
Yellow Hard Exudates
Cotton-wool Spots
Elschnig’s Spots
Papilledema