[Emergency] Atlas of Hypertensive retinopathy

These are pictures of Hypertensive retinopathy. This is a part in Fundoscopic findings of the Atlas of Emergency Medicine book

Clinical Summary

Fundus changes that may be seen with hypertension includegeneralized and focal narrowing of arterioles, generalized arteriolar sclerosis (resembling copper or silver wiring), arteriovenous crossing changes, hemorrhages (usually flameshaped), retinal edema and exudation, cotton wool spots, microaneurysms, and disk edema. Diabetic retinopathy, many hematologic and vascular diseases, traumas, localized ocular pathology, and papilledema should all be considered.

Management and Disposition

The patient’s hypertension should be appropriately treated, and a search for other end-organ damage should be considered. The patient should be referred for appropriate longterm blood pressure management.

Pearls

1. Hypertensive arteriolar findings may be reversible if organic changes have not occurred in the vessel walls. 

2. Always consider hypertensive retinopathy in the differential diagnosis of papilledema. 

FIGURE 3.15 ■ Hypertension. Chronic, severe systemic hypertensive 

changes are demonstrated by hard exudates, increased vessel
light reflexes, and sausage-shaped veins. 

FIGURE 3.16 ■ Copper and Silver Wiring. Arteriolar changes seen 

in hypertensive retinopathy resemble copper (light reflex occupies
most of the width) and silver (light reflex occupies the entire width of the arteriole) wiring.  

REFERENCES

The Atlas of Emergency Medicine, Fourth Edition, 2016.