Overview
Chronic or malignant hypertension can lead to microvascular abnormalities causing problems with the retina and vision.
Presentation
Patients who have chronic hypertension may be asymptomatic but may notice a slight decrease in vision. Patients with malignant hypertension may have headaches and decreased vision.
The Keith-Wagener-Barker classification can stage hypertensive retinopathy based on fundoscopy findings:
- Stage I:
- Arteriolar narrowing and tortuosity
- “Silver wiring”
- Stage II:
- Arteriovenous nipping
- Stage III:
- Cotton-wool exudates
- Flame and blot haemorrhages
- Stage IV:
Management
- Management involves treating the underlying hypertension
Prognosis
- Patients with hypertensive retinopathy have a 2-3-fold increase in the risk of stroke
- Patients are at risk of developing retinal vein occlusions, especially if they have other risk factors such as smoking
