MICROVASCULAR CHANGES IN HYPERTENSIVE RETINOPATHY
DOI:
https://doi.org/10.53555/s7rr8q88Keywords:
Hypertensive retinopathy, Systemic hypertension, Retinal vascular changes, Fundus examination, Ocular complicationsAbstract
Hypertensive retinopathy refers to the spectrum of retinal vascular changes resulting from sustained elevation of systemic arterial blood pressure. Chronic hypertension affects the ocular circulation, leading to retinopathy, choroidopathy, and optic neuropathy, and also predisposes individuals to other vision-threatening conditions such as retinal artery and vein occlusions, retinal artery macroaneurysms, and non-arteritic anterior ischemic optic neuropathy. In addition, hypertension increases the risk of diabetic retinopathy, glaucoma, and age-related macular degeneration and may complicate ophthalmic surgical procedures.
The pathophysiology of hypertensive retinopathy involves autoregulatory vasoconstriction in response to acute blood pressure elevation, followed by progressive structural vascular changes due to chronic hypertension. These changes occur in three stages: the vasoconstrictive phase, characterised by generalised and focal arteriolar narrowing; the sclerotic phase, marked by vascular wall thickening, arteriovenous crossing changes, and characteristic copper and silver wiring; and the exudative phase, resulting from breakdown of the blood-retinal barrier with haemorrhages, cotton wool spots, and hard exudates.
Early identification of hypertensive retinopathy is clinically important, as retinal findings reflect the severity and duration of systemic hypertension and are associated with increased cardiovascular morbidity and mortality. Effective management primarily involves prompt and sustained blood pressure control, along with multidisciplinary evaluation to prevent ocular complications.
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