Hypertensive Retinopathy - Choroidal Ischemia
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39-year-old man two days ago he noticed poor vision in his right eye. He does have diabetes for two years and a history of high blood pressure for about six months, for which he takes medicines.
VISUAL ACUITY: OD: 8/200; OS: 20/20. IOP: 21 in each eye.
SLIT LAMP EXAM: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: C/D ratio is 0.2. There is no posterior vitreous separation. There is a serous macular detachment. There are patchy retinal hemorrhages and cotton wool spots.
OS: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There are patchy retinal hemorrhages and cotton wool spots. There are arterial venous crossing changes.
The OCT scan shows a serous macular detachment in the right eye. The left eye had a normal foveal contour.
A fluorescein angiogram shows a choroidal infarct in the right eye just inferior to the fovea. The left eye has a few hypo- and hyperfluorescent scars and corresponding hemorrhage and cotton wool spots. The infarct perfuses within about fifteen seconds. I checked his blood pressure and it was 240/120. Photos confirm clinical findings.
IMPRESSION:
1. MALIGNANT HYPERTENSION.
2. SEROUS MACULAR DETACHMENT IN THE RIGHT EYE.
3. POSSIBLE OVERLYING DIABETIC RETINOPATHY.
DISCUSSION: I explained to the patient that his blood pressure is high and it is causing him to lose his vision, and there is a risk of other systemic problems in his case. I asked him to go directly to the Emergency Room. I also asked him to return here for a check in six weeks. Once his blood pressure comes under control the eye probably will, but it may take a few months.
ONE YEAR LATER:
pleasant 40-year-old man had hypertensive retinopathy when I saw him in December. His vision has improved now that his blood pressure is under better control. He was diagnosed with IgA nephropathy and he is on medication for that now. He is also diabetic.
VISUAL ACUITY: OD 20/30, OS 20/25. IOP: OD 13, OS 14. The lenses are clear.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. The macula and periphery look healthy.
OS: Vertical C/D ratio is 0.2. The macula and periphery look healthy.
OCT SCAN: The OCT scan of the right eye is back to normal. The left eye shows minimal parafoveal thickening.
IMPRESSION:
1. RESOLVED HYPERTENSIVE RETINOPATHY
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy665 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy531 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy434 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy426 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy500 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy422 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy390 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy381 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy404 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy343 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy341 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy292 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy300 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy406 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy335 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy266 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy with Choroidal Ischemia Right Eye and Vision 8/200 - Blood Pressure 240/120 mmHg IgA Nephropathy287 views39-year-old man two days ago he noticed poor vision in his right eye OD: 8/200; OS: 20/20. BP is 240/120
(0 votes)
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Hypertensive Retinopathy One Year later with good Vision IgA Nephropathy313 viewsOD 20/30, OS 20/25 One year following initial episode.
(0 votes)
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Hypertensive Retinopathy One Year later with good Vision IgA Nephropathy293 viewsOD 20/30, OS 20/25 One year following initial episode.
(0 votes)
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Hypertensive Retinopathy One Year later with good Vision IgA Nephropathy314 viewsOD 20/30, OS 20/25 One year following initial episode.
(0 votes)
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Hypertensive Retinopathy One Year later with good Vision IgA Nephropathy270 viewsOD 20/30, OS 20/25 One year following initial episode.
(0 votes)
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Hypertensive Retinopathy One Year later with good Vision IgA Nephropathy356 viewsOD 20/30, OS 20/25 One year following initial episode.
(0 votes)
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Hypertensive Retinopathy One Year later with good Vision IgA Nephropathy376 viewsOD 20/30, OS 20/25 One year following initial episode.
(0 votes)
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Hypertensive Retinopathy One Year later with good Vision IgA Nephropathy400 viewsOD 20/30, OS 20/25 One year following initial episode.
(0 votes)
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39-year-old man two days ago he noticed poor vision in his right eye. He does have diabetes for two years and a history of high blood pressure for about six months, for which he takes medicines.
VISUAL ACUITY: OD: 8/200; OS: 20/20. IOP: 21 in each eye.
SLIT LAMP EXAM: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: C/D ratio is 0.2. There is no posterior vitreous separation. There is a serous macular detachment. There are patchy retinal hemorrhages and cotton wool spots.
OS: Vertical C/D ratio is 0.3. There is no posterior vitreous separation. There are patchy retinal hemorrhages and cotton wool spots. There are arterial venous crossing changes.
The OCT scan shows a serous macular detachment in the right eye. The left eye had a normal foveal contour.
A fluorescein angiogram shows a choroidal infarct in the right eye just inferior to the fovea. The left eye has a few hypo- and hyperfluorescent scars and corresponding hemorrhage and cotton wool spots. The infarct perfuses within about fifteen seconds. I checked his blood pressure and it was 240/120. Photos confirm clinical findings.
IMPRESSION:
1. MALIGNANT HYPERTENSION.
2. SEROUS MACULAR DETACHMENT IN THE RIGHT EYE.
3. POSSIBLE OVERLYING DIABETIC RETINOPATHY.
DISCUSSION: I explained to the patient that his blood pressure is high and it is causing him to lose his vision, and there is a risk of other systemic problems in his case. I asked him to go directly to the Emergency Room. I also asked him to return here for a check in six weeks. Once his blood pressure comes under control the eye probably will, but it may take a few months.
ONE YEAR LATER:
pleasant 40-year-old man had hypertensive retinopathy when I saw him in December. His vision has improved now that his blood pressure is under better control. He was diagnosed with IgA nephropathy and he is on medication for that now. He is also diabetic.
VISUAL ACUITY: OD 20/30, OS 20/25. IOP: OD 13, OS 14. The lenses are clear.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. The macula and periphery look healthy.
OS: Vertical C/D ratio is 0.2. The macula and periphery look healthy.
OCT SCAN: The OCT scan of the right eye is back to normal. The left eye shows minimal parafoveal thickening.
IMPRESSION:
1. RESOLVED HYPERTENSIVE RETINOPATHY
