The term Hypertensive Retinopathy (HR) means the vascular damage to the retina which is caused by Hypertension or High Blood Pressure. High Blood Pressure is a chronic condition in which the force of the blood against the arteries is too high, this force results from blood pumping away from the heart and into the arteries, as well as the force that results as the heart rests between heartbeats. When blood travels through the body at a higher pressure, arterial tissue can become stretched and this leads to them eventually becoming damaged. Overtime, high blood pressure can lead to retinal blood vessel damage, impairment of the retina's function, and pressure on the optic nerve, which results in vision problems, this condition is known as Hypertensive Retinopathy (HR). When a patient's blood pressure is too high, the retina's blood vessel walls may become thicker, this may result in the blood vessels becoming narrow and as a result causes lack of blood flow to the retina as the path is restricted, in some cases, this can lead to the retinal swelling. Prolonged High Blood Pressure or Hypertension is the typical cause of Hypertensive Retinopathy, this means that the patient's blood pressure has been consistently high for a long period of time. Risk factors of Hypertensive Retinopathy include, diabetes, smoking, being overweight, an unhealthy diet, consuming excessive alcohol and if the patient has an underlying condition such as atherosclerosis or heart disease, it is important to note that high blood pressure can also be hereditary. According to research, Hypertensive Retinopathy is more common in patients of African origin, the condition is also known to be more common in females compared to males.
Symptoms of Hypertensive Retinopathy typically present when the condition has progressed significantly, symptoms include - reduced vision, diplopia, headaches, swelling of eye(s), haemorrhage of blood vessel and clouded vision. An Ophthalmoscope may be used to aid an Optometrist as they examine the retina for any indication of narrowing or leakage from blood vessels. Fundus photography can also be used to detect Hypertensive Retinopathy, signs of early stage Hypertensive Retinopathy on fundus photography include Arteriovenous Nicking or AV Nicking which involves focal narrowing/compression of venules at site of arteriovenous crossing, copper wiring, which involves arteriosclerosis with moderate vascular wall alterations, and silver wiring, which involves more severe vascular wall enlargement and thickening. Hypertensive Retinopathy in its late stages can also be detected using fundus photography, indications of late stage Hypertensive Retinopathy on fundus photography include Flame-shaped haemorrhages (bleeding within the retina usually seen in the posterior region), cotton wool spots (fluffy white spots seen on the retina) which indicate retinal arteriole obstruction and inadequate blood flow to the retina, hard exudates (white-yellow lipid deposits that result from leakage of damaged blood vessels), these can result in decrease of vision if affecting the macula - a build up of these exudates along the outer plexiform layer of the macula can result in the appearance of a macular star which is pictured below in the diagram. Bilateral optic disc oedema or optic disc swelling may also be seen in patients with severe, sudden onset hypertension, symptoms include changes in vision such as dim/double vision, nausea, vomiting and headaches. Bilateral Optic Disc Oedema or Papilledema is a medical emergency and requires immediate investigation.
In order to diagnose Hypertensive Retinopathy, An Ophthalmologist may perform a test known as Fluorescein Angiography to examine the retina's blood flow. In order to perform this procedure, Eye drops must be applied to the patient's eye(s) to dilate the pupils, then photographs of the eye(s) will be taken for the Ophthalmologist to review. After the first round of photographs are taken, the Ophthalmologist will proceed with the test by injecting dye called Fluorescein into a vein (typically on the inside of the elbow), more photographs will then be taken as the dye moves into the blood vessels of the eye for the doctor to determine if Hypertensive Retinopathy is present.
Below are the clinical features that are associated with Hypertensive Retinopathy (HR):
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