Hypertensive Retinopathy
SALIENT FEATURES
Hypertensive retinopathy develops when retinal vascular damage occurs secondary to either hypertensive emergency acutely or chronically elevated blood pressure.
Hypertensive retinopathy may be asymptomatic or, in acute crisis, can present with new-onset symptoms, including blurred vision and visual field defects.1
Slit-lamp examination may reveal cotton wool spots, flame-shaped hemorrhage, exudates, arteriolar narrowing, Elschnig spots, subretinal fluid, pigment epithelial detachments, and papilledema. Less commonly with severe ischemia, retinal neovascularization may develop.1
Microvascular retinal changes during chronic hypertension occur prior to most reporting of visual symptoms.1
OCT FEATURES
Hypertension is associated with inner retinal atrophy/thinning.2
Thinning of the ganglion cell inner plexiform layer in hypertensive eyes correlates with decrease in retinal blood flow per optical coherence tomography angiography (OCTA).
Peripapillary retinal nerve fiber layer (RNFL) and central macular thickness in eyes manifesting significant ischemia are significantly reduced.
FIGURE 19.1 (A and B) Swept-source optical coherence tomography (SS-OCT) with macular subretinal fluid, solid hyperreflective deposits overlying the retinal pigment epitheium (RPE) and splitting of the ganglion cell and nerve fiber layer with retinal irregularity. (Reprinted with permission from Rotsos T, Andreanos K, Blounas S, Brouzas D, Ladas DS, Ladas ID. Multimodal imaging of hypertensive chorioretinopathy by swept-source optical coherence tomography and optical coherence tomography angiography: case report. Medicine (Baltimore). 2017;96(39):e8110.)
Cotton wool spots are hyperreflective on optical coherence tomography (OCT), a finding which may persist on imaging even after they become unobservable on examination. Focal thinning in the RNFL and inner retina may be noted following cotton wool spot resolution.
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