Hypertension and the Eye

    • CE credits 2 hours
    • COPE code 70567-SD / 120941
    • Available until Dec 24, 2023

Introduction

Objectives

  • To review the ocular manifestations of hypertension, especially hypertensive retinopathy
  • To review the pathophysiology of hypertensive damage to the eye
  • To review the assessment of risk in clinical studies

Case

A 54 year old female presents to your office for an eye check-up. She has not seen an optometrist in over 10 years, and never required glasses or had any problems with her eyes. She has no specific concerns.

The patient tells you she is otherwise healthy, although again she has not seen a medical doctor in over 10 years. She is on no medications and has no allergies to medications. Family history is unremarkable.

On exam best-corrected visual acuity is 20/40 bilaterally. Pressures are normal at 12 and 13 in the right and left eyes, respectively. Anterior segment exam is normal in both eyes. On dilated fundoscopy of the right eye, the following fundus image is seen. A similar appearance is seen in the left eye.

Diagnosis

Quick Question: What is the most likely diagnosis?

  • Diabetic retinopathy

    Although diabetic and hypertensive retinopathy may appear similar (and often coexist), the fundus appearance is more typical of hypertensive retinopathy, especially with the degree of arteriolar narrowing and lack of hemorrhages.

  • Hypertensive retinopathy
    Correct
  • AIDS retinopathy

    AIDS retinopathy is the most common posterior segment finding in HIV+ patients, and presents typically with cotton wool spots and retinal hemorrhages, neither which are seen in this fundus photo. There are also no clues in the history to suggest this patient is HIV+.

  • Cat Scratch Disease

    Cat scratch disease is a disease caused by the Bartonella bacteria commonly spread by scratches or bites from cats. Cat scratch disease has several ocular manifestations including granulomatous conjunctivitis and neuroretinitis. However it is more common in children and would not cause all fundus changes seen in the photograph.

Hypertensive retinopathy is the second most common type of retinopathy worldwide, behind only diabetic retinopathy.1 It is defined as changes to the retinal vasculature occurring as a result of prolonged or severely elevated blood pressure. Signs of the condition are present in 2-14% of the non-diabetic population over the age of 40.2-4 Although more common with aging, approximately 8.6% of hypertensive children are affected by retinopathy.5

Hypertension-mediated damage to the eye is classically divided into hypertensive retinopathy (the most common manifestation and focus of this module), hypertensive choroidopathy, and hypertensive optic neuropathy. This module will discuss each separately.

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