To view more masterclasses download our ophthalmology app at
play.google.com/store/apps/de...
Hypertensive Retinopathy :@0:10
Components:
Retinopathy - Damage to the retina
Choroidopathy - Damage to the choroid
Neuropathy - Damage to the neurons
Retinopathy :@0:51
1. Acute
Due to vasospasm
2. Chronic
Due to arteriosclerosis
Classification:@1:24
→ Modified scheie’s classification of hypertensive retinopathy
Grade O → No changes
Grade 1 → Barely detectable arterial narrowing
Grade 2 → Obvious arterial narrowing with focal irregularities
Grade 3 → Grade 2 plus retinal hemorrhages, exudates
Grade 4 → Grade 3 plus disc swelling
Grade 3 :
→ Flame shaped haemorrhages on nerve fiber layer of retina
→ Soft exudates/ cotton wool spots (collection of axoplasmic debris on retina)
Artery-Vein Crossings :
→ Mostly artery cross over the veins (75% of times)
Very slow painless loss of vision (changes happen over 20 - 30 yrs.)
Internally normal aqueous flow is seen ( Normal aqueous production → 2.5 𝛍L/min)
Normal “C” value (aqueous flow rate) → 0.2 𝛍L/min / mm of Hg
Above two values will ↑ due to → Trabecular blockade.
Artery-Vein(AV) Crossings :@2:40
→ Mostly artery cross over the veins (75% of times)
→ Veins cross over the arteries (25% of times)
→ In hypertension, arteriosclerosis occurs, which compress the vein
→ Maximum AV crossings present in supero temporal quadrant
→ BRVO: (Branched retinal venous occlusions)
Maximally present at supero temporal quadrant
Normal Artery-Vein(AV) Ratio:@3:55
→ Normal AV ratio → 2 : 3
→ In hypertension retinopathy, AV ratio changes
AV nipping/ Nicking occurs
Focal Signs Of Grade 2:@4:41
→ Gunn’s sign: Tapering of veins on either side of crossing
→ Bonnet’s sign: Banking of veins distal to AV crossing
→ Salus sign: Deflection of vein after AV crossing
→ Accelerated Hypertension: HTN which leads to end organ damage
→ Malignant Hypertension: Accelerated HTN + Disc edema
→ Copper wiring & silver wiring:
Indicates the colour of blood column
Seen in advanced hypertensive retinopathy
Malignant Hypertension: Accelerated HTN + Disc edema @7:42
Copper & Silver Wiring Sign:@7:50
→ Copper wiring & silver wiring:
Indicates the colour of blood column
Seen in advanced hypertensive retinopathy
Acute Choroidopathy:@8:08
→Elschnig’s spots:
Hyper pigmented spots surrounded by hypo pigmentation
→Siegrist spots:
Linear hyperpigmentation's follow choroidal arteries
Acute optic neuropathy → Contains optic disc edema.