65. Vascular alterations of the retina due to arterial hypertension, sclerosis, renal diseases and toxaemic retinopathy of pregnancy
Covers fundus changes in systemic hypertension, explaining the three mechanisms behind them: arteriolar vasoconstriction, arteriosclerotic thickening of vessel walls, and hypoxia-driven vascular leakage causing haemorrhages, exudates and retinal oedema. It then sets out a four-grade classification, describing each grade's arteriolar narrowing and signs such as the Salus, copper-wire, bonnet, Gunn and silver-wire signs, plus flame haemorrhages, hard exudates and papilloedema.
Topic 65 of 91 in the MU Sofia syllabus for Ophthalmology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 129 words (1 min of reading), with 15 flashcards.
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Hypertensive retinopathy
Hypertensive retinopathy
-fundus changes occurring in patients with systemic hypertension
- Mechanism:
1. Vasoconstriction → primary response of the retinal arterioles after high bp (linked with severity of High blood pressure)
2. Arteriosclerotic changes → thickening of vessel wall (linked with duration of Hp)
3. Increased vascular perm. → Due to hypoxia → haemorrhages, exudates &retinal oedema
Grading: 1 → mild generalised arteriolar attenuation especially small branches, light reflex broadens and veins concealed Grade 2→ severe generalised narrowing with Salus sign = deflection of veins at AV crossing Grade 3 → changes in 2 + copper wired look +bonnet sign= banking of veins distal to AV, Gunn sign diminishing of veins on both sides of vein, flame shaped haemorrhages + hard exudates Grade 4→ changes in 3+ silver wired look+ papilloedema
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