Hypertensive retinopathy for general public

Systemic hypertension can affect the eyes especially retina even before the patient gets  other symptoms of systemic hypertension. They are usually at age between 3rd to 4th decade and usually symptoms are severe in accelerated or malignant hypertension.
   They come to ophthalmologist with complains of sudden blurring of vision , headache, dizziness.

 Hypertension can effect the retina leading to retinopathy, choroid leading to choroidopathy and optic nerve leading to optic neuropathy.

Hypertensive retinopathy: 
   They go through various stages. Initially characterized by severe arteriolar attenuation with presence of intraretinal hemorrage, cotton wool spots in posterior pole usually more than we see in diabetic retinopathy. Microanuerysms are rare than macroaneurysms. They may have macular edema and hard exudates deposition in long term.

Hypertensive choroidopathy:
   Characterised by presence of liner streaks in mid periphery as seigerts streaks and pigmented lesions called elshnig's spots with FFA showing non perfusion of specific lobules of choroid leading to triangular sign of amalric.

Hypertensive optic neuropathy:
  Characerised by presence of disc edema /papilloedema leading to severe decrease in vision.


Hypertension is also most common risk factor for certain retinal vascular condition which lead to decrease in vision like:

•   Vein occlusion
•   Arteriolar occlusion
•   Retinal artery macroanueyrsm
•   Nonarteritic anterior ischemic optic neuropathy ( NAAION)

Investigations:
 Most important if patient is not a known case of hypertension to get his blood pressure test done.

OCT( optical coherance tomography) to check for macular edema and disc swelling.

Fundus fluroescein angiography/ Indocyanine green angiography  if suspected hypertensive choroidopathy.

Treatment:
 Immediate referral to physician for reducing the blood pressure gradually over a week. Aggresive management with sudden decrease in blood pressure can deteriorate the condition.
Anti Vegf injections will help to decrease the macular edema .

Prognosis:
  If optic nerve is involved then prognosis is not so good, otherwise hypertensive retinopathy once blood pressure is decrease prognosis is better .

Prevention:
  Its important to have yearly once checkup for hypertensive retinopathy in known case of systemic hypertensive even if patient doesnt have any symptoms.
Any sudden blurring of vision even for few minutes only, headache, dizziness need to meet ophthalmologist.