Mark O M Tso, MD
Systemic hypertension can cause choroidopathy, retinopathy, and optic neuropathy. Hypertensive retinopathy can be caused by pregnancy, renal disease, pheochromocytoma, and collagen diseases such as lupus. Young patients may have acute hypertension without sclerotic vessels. Hypertension may contribute to retinopathy in patients with diabetes.
On fundus examination, the classic sign of hypertensive retinopathy is a macular star: profuse dilated retinal vessels radiating from the edge of the macula. Retinal detachment may also be a sign of hypertensive retinopathy. On fluorescein angiography, look for hypoperfused areas that leak fluorescein in late-stage frames.
Blood pressure in excess of 160/100 mm Hg is considered severe hypertension. Accelerated hypertensive retinopathy may occur with blood pressures around 240/180 mm Hg, and is characterized by exudative and ischemic retinal pathology.
Complications of chronic hypertensive retinopathy include macroaneurysms and circinate retinopathy, epiretinal membranes and tractional retinal detachments, and central or brance retinal vessel occlusion (CRVO/BRVO).
Treatment of hypertensive retinopathy must be tailored to the pathogenetic mechanism.
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