Chronic Hypertensive Retinopathy: Pathogenesis and clinical findings



Ophthalmic Artery Hypertension

Stage 1: Mild/vasoconstrictive

 • Acute and chronic vasospasm -> Diffuse and focal arterial narrowing and vascular tortuosity

Stage 2: Moderate/sclerotic

 • Atherosclerosis and hyalinization causes arteriolar wall thickening resulting in a diffuse light reflex appearing red-brown coloured -> Copper Wiring

 • Thickening of the arteriolar wall and/or sclerotic thickening at the arteriole/venule crossing compresses the underlying venule -> AV nicking

Stage 3: Severe/exudative

 • BRB breakdown causes dot/blot hemorrhages in the inner retina and flame hemorrhages in the nervefiber layer -> Retinal Hemorrhages

 • Serum proteins and lipids leakage from damaged BRB appears as white or yellow areas with sharp margins -> Yellow Hard Exudates

 • Occlusion of the terminal retinal arterioles causes fluffy white ischemic lesions in the inner retinal nerve fiber layer -> Cotton-wool Spots

Stage 4: Malignant

 • Hyper-pigmented patches surrounded by a hypo-pigmented ring due to RPE clumping around atrophic areas in the choroid -> Elschnig's Spots

 • Ischemia of optic disc arterioles causes optic nerve swelling and blurred disc margins. Leakage of optic disc arterioles causes hemorrhage and disc edema. -> Papilledema



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