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Retinal Vascular Disease

Hypertensive Retinopathy

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spacer 58 million Americans are hypertensive.
  • 38% of black adults; 29% of white adults
  • 75% of people over age 65
20% of all hypertensives are undiagnosed. Primary hypertension comprises 85-90% of all cases.
Hypertensive Retinopathy

The retinal vasculature allows a unique opportunity to observe the damage caused by hypertension. There are many associated retinal findings:
  • Arteriosclerosis, or arterial hardening, is an early finding. At the beginning, the arteries undergo a generalized narrowing which can be graded.

    Grade Iarteries 3/4 normal caliber
    Grade IIarteries 1/2 normal caliber
    Grade IIIarteries 1/3 normal caliber
    Grade IVarteries thread-like or invisible

    Narrowing triples the risk of CHD in patients with hypertension (HTN) and increased lipid levels!
  • Generalized sclerosis (increases the ALR) also occurs as does focal constriction. Again, these can both be assigned a grade.
  • Other findings include flame-shaped nerve-fiber-layer hemorrhages, cotton-wool spots, exudative edema, vessel sheathing, and vessel tortuosity (often seen in normals). Crossing changes are common (Gunn's sign). Papilledema can be seen in advanced cases. Significantly associated with vein occlusions.

Malignant hypertension is not a separate entity but is merely advanced hypertension with associated secondary complications. Ocular findings are severe and include exudative edema and papilledema. Very poor prognosis.

The choroidal vasculature is also highly susceptible to hypertensive damage. Common findings include chorio-retinal atrophy with pigment disturbances (Elschnig's spots) and coalesced areas of chorio-retinal atrophy (Siegrist's streaks). Significant asymmetry often indicative of carotid obstruction.

Select picture or text to view a larger image.
small photo of papilledema associated with malignant hypertension Papilledema associated with malignant hypertension
small photo of papilledema associated with malignant hypertension Papilledema associated with malignant hypertension
small photo of macroaneurysm Macroaneurysm


There is no ocular treatment for hypertensive retinopathy; manage by controlling systemic disease.

Go to: Retinal Vascular Disease CE Table of Contents

Revised: October 17, 2002
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