Grades of hypertensive retinopathy. (A) Mild hypertensive retinopathy (in an eye with an unrelated chorioretinal lesion) with arteriolar narrowing (white arrow), copper wiring (black star), and AV nicking (black arrow). (B) Moderate hypertensive retinopathy with features of mild hypertensive retinopathy as well as cotton wool spots (yellow arrow) and intraretinal hemorrhages (red arrow). (C) Severe hypertensive retinopathy with features of moderate hypertensive retinopathy and optic disc swelling (white star). | Tsukikawa, M., & Stacey, A. W. (2020). A Review of Hypertensive Retinopathy and Chorioretinopathy. Clinical optometry, 12, 67–73. https://doi.org/10.2147/OPTO.S183492
Diagnosis
Funduscopic exam:
Copper wiring
AV nicking
Cotton-wool spots
Intraretinal hemorrhages
Elschnig spots
Optic disc swelling
Optos wide-field color fundus photographs of the right eye (A) and left eye (B) of a patient with hypertensive chorioretinopathy. The photographs demonstrate copper wiring (black star), AV nicking (black arrow), intraretinal hemorrhages (red arrow), cotton wool spots (yellow arrow), Elschnig spots (white asterisk), and optic disc swelling (white star). | Tsukikawa, M., & Stacey, A. W. (2020). A Review of Hypertensive Retinopathy and Chorioretinopathy. Clinical optometry, 12, 67–73. https://doi.org/10.2147/OPTO.S183492
Optical coherence tomography (OCT):
Thinning of the inner retina
Focal attenuation of the ellipsoid zone in areas of the Elschnig spots
Pigmentary epithelial detachments
Serous retinal detachments
Optical coherence tomography of the macula of the right eye (A) and left eye (B) of a patient with hypertensive chorioretinopathy shows macular edema and serous retinal detachments. These serous retinal detachments improved after medical management of hypertension. | Tsukikawa, M., & Stacey, A. W. (2020). A Review of Hypertensive Retinopathy and Chorioretinopathy. Clinical optometry, 12, 67–73. https://doi.org/10.2147/OPTO.S183492
Fundus autofluorescence:
Hypoautofluorescence of Elschnig spots
Hypoautofluorescence due to intraretinal hemorrhages and cotton wool spots
Fundus autofluorescence of the right eye (A) and left eye (B) of a patient with hypertensive chorioretinopathy. Magnification of the posterior pole reveals hypoautofluorescence of Elschnig spots, retinal hemorrhages and cotton wool spots. | Tsukikawa, M., & Stacey, A. W. (2020). A Review of Hypertensive Retinopathy and Chorioretinopathy. Clinical optometry, 12, 67–73. https://doi.org/10.2147/OPTO.S183492
Fluorescein angiography:
Patchy and delayed choroidal filling
Severely delayed retinal arterial filling with areas of retinal capillary nonperfusion
Elschnig spots appear as areas of early hyperfluorescence with late subretinal leakage
Optic disc leakage and blockage from cotton wool spots and intraretinal hemorrhages
Indocyanine green (ICG) angiography: Demonstrates hypocyanescence of ischemic areas of the choroid.10
Fluorescein angiography of the right eye (A) and left eye (B) of a patient with hypertensive chorioretinopathy shows patchy and delayed choroidal filling and areas of retinal capillary nonperfusion. There is also blockage from intraretinal hemorrhages and cotton wool spots, as well as optic disc leakage. | Tsukikawa, M., & Stacey, A. W. (2020). A Review of Hypertensive Retinopathy and Chorioretinopathy. Clinical optometry, 12, 67–73. https://doi.org/10.2147/OPTO.S183492