Retinal Disease

Question 1

Describe the grades of hypertensive retinopathy.

Answer 1

I Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
II Arteriovenous nipping- the crossing of a hardened arteriole over a vein causing compression of the vein and bulging on each side, focal arteriolar narrowing, A ‘copper wiring’ opacified appearance of arteriolar walls may be seen
III Cotton-wool exudates
Flame and blot haemorrhages
Exudates (chronic retinal oedema may result in the deposition of hard exudates around the fovea as a ‘macular star’
IV Papilloedema

Question 2

What are signs of hypertensive choroidopathy

Answer 2

Elschnig spots are focal choroidal infarcts seen as small black spots surrounded by yellow haloes

Siegrist streaks are flecks arranged linearly along choroidal vessels, and are indicative of fibrinoid necrosis associated with malignant hypertension.

Exudative retinal detachment , sometimes bilateral, may occur in acute severe hypertension such as that associated with toxaemia of pregnancy.