SEARCH RESULTS FOR: Chronic-Hypertensive-Retinopathy

chronic-hypertensive-retinopathy-pathogenesis-and-clinical-findings

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

Chronic Hypertensive Retinopathy

Stage 4: Malignant Fibrinoid necrosis of choroidal arterioles & choroidal lobule ischemia ↓ Perfusion to choriocapillaris Optic disc arteriole ischemia **See corresponding Calgary Guide Side Legend: Pathophysiology Sign/Symptom/Lab Finding Chronic Hypertensive Retinopathy: Pathogenesis and clinical findings 1o Hypertension risk factors (ex. ↑ age, family history, diet, smoking, alcohol, stress) 2o Hypertension risk factors (ex. Cushing’s Syndrome**, hypothyroidism**, hyperthyroidism**, acromegaly, diabetes mellitus**) Ophthalmic Artery Hypertension (HTN) ↑ Blood pressure in the ophthalmic artery (branch of the internal carotid artery) Persistent ↑ systemic blood pressure Authors: Emily J. Doucette, Kareem Sadek, Graeme Prosperi-Porta Reviewers: Stephanie Cote, Usama Malik, Johnathan Wong*, Mary Holdsworth* * MD at time of publication Stage 1: Mild/vasoconstrictive Stage 2: Moderate/sclerotic Stage 3: Severe/exudative Focal arteriole weakening from chronic HTN Retinal arterial macroaneurysm (risk of hemorrhage or exudation) Acute & chronic vasospasms ↑ vasomotor tone Generalized arterial narrowing & vascular tortuosity Retinal arteriolar sclerosis & thickening at arteriole- venule crossings Arteriovenous nicking (venule compressed by arteriole) Branch retinal vein occlusion (sectoral hemorrhages & macular edema) Central retinal artery occlusion (CRAO)** Copper wiring (reflected light appears red-brown) Chronic retinal hypoperfusion (progressive vision loss) Persistent HTN causes arteriolar wall thickening, hyaline arteriosclerosis, & atherosclerotic changes Central retinal vein occlusion (CRVO)** Fragile microaneurysms or sclerotic vessels rupture into vitreous cavity Floaters & sudden painless vision loss Vitreous hemorrhage Branch retinal artery occlusion (partial vision loss & retinal pallor) Arteriolar changes ↑ risk of vessel occlusion Terminal retinal arteriole occlusion Focal ischemia of nerve fiber layer of retina Cotton-wool spots (fluffy white ischemic lesions on fundus exam) Dot-blot & flame retinal hemorrhages (inner retina & nerve fiber layer) Chronic HTN results in endothelial dysfunction & vascular leakage Damaged blood-retinal barrier breaks down, leaking whole blood, serum proteins, & lipids Extrusion of a fibrin plug at site of rupture Roth spots (white-centered retinal hemorrhages) Retinal detachment (retina separates from pigment epithelium) Siegrist streaks (linear hyperpigmented streaks overlying choroidal vessels) Yellow hard exudates (lipid- protein retinal deposits) Hard exudates align radially with nerve fiber orientation Retinal pigment epithelium clumps around atrophic areas in the choroid Elschnig’s spots (hyperpigmented patches surrounded by a hypo-pigmented ring) “Macular star” pattern Optic disc edema & disc pallor Chronic optic neuropathy (irreversible vision loss with optic nerve atrophy) Published Jun 28, 2017; updated Feb 17 2026 on www.thecalgaryguide.com Mechanism Complications