Hypertensive Retinopathy

Question 1

What is Hypertensive Retinopathy?

Answer 1

• Damage to the small blood vessels in the retina relating to systemic hypertension
• Due to years of Chronic hypertension or quickly due to malignant hypertension

Question 2

What are the key signs you would see on Fundoscopy?

Answer 2

• Silver wiring/ Copper wiring
• Arteriovenous nipping
• Cotton wool spots
• Hard exudates
• Retinal Haemorrhages
• Papilloedema

Question 3

What is the cause of silver/ copper wiring?

Answer 3

• The walls of the arterioles become thickened and sclerosed causing increased reflection of the light

Question 4

What is Arteriovenous Nipping?

Answer 4

• Where the arterioles cause compression of the veins where they cross. This is due to sclerosis and hardening of the arterioles

Question 5

What are Cotton Wool spots?

Answer 5

• Caused by ischaemia and infarction in the retina causing damage to nerve fibres

Question 6

What are Hard Exudates?

Answer 6

• Damaged Vessels leaking lipids into the retina

Question 7

What are Retinal Haemorrhages?

Answer 7

• Caused by damaged vessels rupturing and releasing blood into the retina

Question 8

What is the classification system for Hypertensive Retinopathy called?

Answer 8

• Keith-Wagener Classification

Question 9

What are the Stages of the Keith-Wagener Classification?

Answer 9

1. Mild narrowing of the arterioles
2. Focal constriction of blood vessels and AV nicking
3. Cotton-wool patches, exudates and haemorrhages
4. Papilloedema