Mild Hypertensive Retinopathy

Overview

Mild hypertensive retinopathy is characterised by one ore more of the following:
1. General or focal arteriolar narrowing
2. Arteriovenous nipping (nicking)
3. Increasing opacity of the arteriolar wall (copper wiring or broadening of the arteriolar light reflex).

Signs may be subtle, and they may be present concurrently with other pathologies.

Case Examples

Case 1

A 60-year-old South American female who has type 2 diabetes (diagnosed 5 years previously), systemic hypertension and is a regular smoker. Her in-office blood pressure measurement was 203/91 mmHg. This was communicated to her GP on the day of her eye examination and prompt follow-up with her GP was arranged.

Her best corrected visual acuity was 6/6 (20/20) in each eye.

Fundus photograph and red free image (right eye)

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Fundus photograph and red free image (right eye)

Arteriovenous (AV) nipping may be seen in the superior arcuate vessels.
Blood vessel tortuosity was also noted. There were no signs of diabetic retinopathy.

Fundus photograph and red free image (left eye)

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Fundus photograph and red free image (left eye)

AV nipping may be seen in the superior arcuate vessels.
Blood vessel tortuosity was also noted. There were no signs of diabetic retinopathy.

Magnified fundus photo (left superior vascular arcade)

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Magnified fundus photo (left superior vascular arcade)

The fundus photo and red-free image show Bonnet's sign (diversion of the vein by the artery) and AV nipping.
Case 2

A 70-year-old Caucasian female with systemic hypertension, treated with medication. Her in-office blood pressure measurement was 139/90 mmHg. Her best corrected visual acuity was 6/6 (20/20) in each eye.

Fundus photograph and red-free image (right eye)

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Fundus photograph and red-free image (right eye)

Retinal photos show mild generalised arteriolar narrowing and arteriovenous (AV) crossing changes. Salus's sign is present at the first AV crossing in both the superior and inferior vascular arcades.

Fundus photograph and red-free image (left eye)

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Fundus photograph and red-free image (left eye)

Retinal photos show generalised arteriolar narrowing and AV crossing changes superiorly in the left eye.

Differential diagnosis

References

Wong,TY, Mitchell,P (2004) Hypertensive Retinopathy. N Engl J Med 351:2310-2317

Mild Hypertensive Retinopathy

Overview

Case Examples

Fundus photograph and red free image (right eye)

Fundus photograph and red free image (left eye)

Magnified fundus photo (left superior vascular arcade)

Fundus photograph and red-free image (right eye)

Fundus photograph and red-free image (left eye)

Differential diagnosis

Moderate hypertensive retinopathy

Non-proliferative diabetic retinopathy

Ocular ischaemic syndrome

References