🩺HypertensiveRetinopathy – When Blood Pressure Hits the Retina

Welcome to the DeepDive. In this episode, we’re unpacking hypertensiveretinopathy — a key ophthalmology topic and classic MSRA favourite.

We’ll take youthrough what it is, how it develops, how it looks on fundoscopy, and why it's avital clue to wider systemic disease. All explained clearly, with mnemonics andclinical pearls to make it stick.

👁️Definition:

Hypertensiveretinopathy = retinal damage from chronic highblood pressure. The sustained vascular pressure causes progressivechanges in retinal arterioles, leading to visual changes and a reflection ofsystemic risk.

🧠Grading –Keith-Wagner-Barker Classification (Stages I–IV):

🔹Stage I

• Arteriolar narrowing
• “Silver wiring” – shiny, reflective vessels
• 🧠 Mnemonic: Skinny, wiggly, silver vessels

🔹Stage II

• AV nicking/nipping (artery compresses underlying vein)
• 🧠 Mnemonic: Artery nips the vein

🔹Stage III

• Cotton wool spots (nerve fibre infarcts)
• Flame + blot hemorrhages
• Hard exudates (macular star possible)
• 🧠 Mnemonic: Fluffy white & red spots, star in the centre

🔹Stage IV

• Papilledema (optic disc swelling)
• Sign of malignant hypertension – emergency
• 🧠 Mnemonic: Papa of all signs

🧬Pathophysiology:

🔸 High BP → endothelial damage → arteriolosclerosis

🔸 Vessel narrowing → ischemia → cotton wool spots

🔸 Leakage → hemorrhages, exudates

🔸 Severe ↑BP → optic disc swelling (papilledema)

⚠️Risk Factors:

• Long-standing hypertension
• Poor BP control
• Smoking, diabetes, obesity, sedentary lifestyle
• Increasing age

🔍Clinical Features:

🧑‍⚕️Exam findings(Fundoscopy)

• Narrowed/tortuous vessels
• AV nicking
• Hemorrhages (flame/blot)
• Cotton wool spots
• Hard exudates
• ± Papilledema in severe disease

👁️Patient symptoms

• Often asymptomatic early
• Blurred vision, visual field loss in advanced stages

🩻Investigations:

• Dilated fundoscopy
• OCT (for macular oedema)
• Fundus photography
• Fluorescein angiography (if needed)
• BP monitoring – essential for diagnosis and management

💊Management:

✔️Primary aim: Control blood pressure

• Antihypertensives
• Lifestyle changes: stop smoking, exercise, healthy diet
• Regular retinal exams
  ✔️ Urgent ophthalmology referral for stage IV/malignant hypertension

📈Prognosis:

• Good if BP is controlled early
• Some changes are reversible
• If untreated → risk of permanent vision loss, macular oedema, or optic neuropathy

🚨Complications toKnow:

• Visual field loss
• Retinal haemorrhages
• Macular oedema
• Ischemic optic neuropathy
• Retinal detachment (rare)

📚Useful Resources

• Revision Notes → https://www.passthemsra.com/topic/hypertensive-retinopathy-revision-notes/

• Flashcards → https://www.passthemsra.com/topic/hypertensive-retinopathy-flashcards/

• Accordion Q&A→ https://www.passthemsra.com/topic/hypertensive-retinopathy-accordion-qa-notes/

• Rapid Quiz → https://www.passthemsra.com/topic/hypertensive-retinopathy-rapid-quiz/

• Quiz Link → https://www.passthemsra.com/quizzes/hypertensive-retinopathy/

🧠MSRA Key Takeaway:

Hypertensiveretinopathy is not just an eye issue — it's a red flag for systemic vascular damage. Know the grading,know the signs, and remember: BP control =retina protection.

🔗 Check out PassTheMSRA.com and FreeMSRA.com for more revision content, quizzes, and tools to sharpen your prep.

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