A Case Report of Hypertensive Retinopathy
Title: A Case Report of Hypertensive Retinopathy
Author: Tyler Scott Quist, BS
Photographer: James Gilman
Keywords/Main Subjects: Hypertensive retinopathy, hypertensive emergency
Hypertensive retinopathy refers to the microvascular changes of the retina that occur in the setting of hypertension and is a common cause of ocular disease. Hypertensive emergency refers to a systolic blood pressure (SBP) ≥ 180 and/or diastolic blood pressure (DBP) ≥ 120 with evidence of end organ damage, such as retinopathy.
A 40-year-old male with a history of newly diagnosed systolic blood pressure over 200 presents with a three-week history of bilateral blurry vision and halos worse in the left eye. The patient reported new-onset migraines and denied any other ocular symptoms. On exam, his visual acuity was 20/25 and 20/150 in the right and left eye, respectively. Tonometry, pupils, visual fields, extraocular movements, and slit lamp exam were unremarkable. The fundus exam was remarkable for bilateral optic disc edema and hemorrhage, macular hemorrhages and exudates, and arteriolar narrowing as shown in Figure 1. The patient was sent to the emergency department, where magnetic resonance imaging (MRI) revealed a small stroke in the corpus collosum. The patient was treated for hypertensive emergency with antihypertensives and his vision slowly improved over the course of several months.
Hypertension results in retinal microvascular changes called hypertensive retinopathy, which may be categorized as mild, moderate, or severe. The mild form is characterized by retinal arteriolar narrowing, the moderate form is characterized by hemorrhages and exudates, and the severe form is characterized by optic disc edema1. Hypertensive retinopathy is more common with increased age and among black persons and has a prevalence rate from two to fifteen percent1. Patients with malignant hypertensive retinopathy may present with blurry vision, decreased visual acuity, eye pain, and headaches. The dilated fundoscopic exam and coexisting hypertension is paramount in establishing the correct diagnosis and classification of the disease. Previously published literature has shown that reducing systemic blood pressure below 140/90 mmHg improves hypertensive retinopathy2,3. However, it is uncertain whether antihypertensive agents with a direct effect on microvasculature have any benefit over other antihypertensive medications.
- Wong TY, Mitchell P. Hypertensive retinopathy. N Engl J Med 2004;351:2310.
- Bock KD. Regression of retinal vascular changes by antihypertensive therapy. Hypertension 1984;6:III-158.
- Dahlof B, Stenkula S, Hansson L. Hypertensive retinal vascular changes: relationship to left ventricular hypertrophy and arteriolar changes before and after treatment. Blood Press 1992;1:35-44.
Faculty Approval By: Dr. Amy Lin
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Disclosure (Financial or other): No authors have any financial or proprietary interest in any material or methods mentioned.