Chronic Hypertensive Retinopathy: Pathogenesis and clinical findings Ophthalmic Artery Hypertension Stage 1: Mild/vasoconstrictive • Acute and chronic vasospasm -> Diffuse and focal arterial narrowing and vascular tortuosity Stage 2: Moderate/sclerotic • Atherosclerosis and hyalinization causes arteriolar wall thickening resulting in a diffuse light reflex appearing red-brown coloured -> Copper Wiring • Thickening of the arteriolar wall and/or sclerotic thickening at the arteriole/venule crossing compresses the underlying venule -> AV nicking Stage 3: Severe/exudative • BRB breakdown causes dot/blot hemorrhages in the inner retina and flame hemorrhages in the nervefiber layer -> Retinal Hemorrhages • Serum proteins and lipids leakage from damaged BRB appears as white or yellow areas with sharp margins -> Yellow Hard Exudates • Occlusion of the terminal retinal arterioles causes fluffy white ischemic lesions in the inner retinal nerve fiber layer -> Cotton-wool Spots Stage 4: Malignant • Hyper-pigmented patches surrounded by a hypo-pigmented ring due to RPE clumping around atrophic areas in the choroid -> Elschnig's Spots • Ischemia of optic disc arterioles causes optic nerve swelling and blurred disc margins. Leakage of optic disc arterioles causes hemorrhage and disc edema. -> Papilledema #Chronic #Hypertensive #Retinopathy #pathophysiology #ophthalmology #diagnosis #signs #symptoms #complications
