What are the ocular findings in hypertensive retinopathy? The direct visualization of retinal vessels in the retinal mapping exam serves to evalua...

What are the ocular findings in hypertensive retinopathy?

The direct visualization of retinal vessels in the retinal mapping exam serves to evaluate the degree of hypertensive retinopathy and provide information on hypertension to clinicians, cardiologists, and nephrologists.
The most common type of hypertensive retinopathy is associated with asymptomatic chronic hypertension.
The classic finding of chronic hypertensive retinopathy is pathological arteriovenous crossing.
The malignant hypertensive retinopathy is associated with hypertensive nephrosclerosis and high risk for hypertensive encephalopathy and acute pulmonary edema.
Unlike chronic hypertensive retinopathy, malignant hypertensive retinopathy can cause visual symptoms such as headache, scotomas, photopsia, metamorphopsia, and visual blurring.
The first alteration in hypertensive retinopathy is vasoconstriction. In the acute phase, the sign is focal; with chronicity, it becomes diffuse. We will observe arteriolar narrowing and tortuosity and focal venous dilations adjacent to the arteriovenous crossing.
The vascular alterations of hypertensive retinopathy are confused with those of senile arteriolosclerosis, which can be found even in non-hypertensive elderly people. In this case, the most important characteristic is the increased arteriolar brightness.
If hypertension is severe, arteriolar obstruction may occur, forming cotton wool exudates. Vascular leaks are also prone to occur, leading to intraretinal hemorrhages 'in candle flame' and even retinal edema, hard exudates, and optic disc edema.