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56-year-old man was seen in the office on March 11, 2013. He was hospitalized for five days a few weeks ago for increased high blood pressure. He said when he was hospitalized he is not sure, but his systolic blood pressure was in the high 200s and the diastolic pressure was in the mid 100s. His vision is reasonable in both eyes. He is not noticing any pain or discomfort. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: 9 OU. SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There are 2+ cotton wool spots on the macula. OS: Vertical C/D ratio is 0.1. There is 1+ optic nerve edema and 2+ cotton wool spots. SPECTRALIS-SD-OCT SCAN: The nerve fiber layer scan shows thickening of the nerve fiber layer in both eyes. The average thickness in the right eye is 109 microns with thickening of the superior and inferior pole. The left eye has 133 microns with thinning of the superior, but thickening of the inferior pole of the nerve. COLOR PHOTOS: The photos show the cotton wool spots in the macula of both eyes. IMPRESSION: 1. HYPERTENSIVE RETINOPATHY – BOTH EYES WITH COTTON WOOL SPOTS AND OPTIC NERVE EDEMA DISCUSSION: I explained to the patient that he does have manifestations of hypertensive retinopathy in both eyes. Generally when the blood pressure is controlled, the retina normalizes, but he may end up with a little bit of optic atrophy depending on how severe the ischemic insult to the eye was. I asked him to return for a check in six weeks so I can repeat some of the testing.

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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 1141 views00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 980 views00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 962 views00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 921 views00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 760 views00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 663 views00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 487 views00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 507 views00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 439 viewsMacular Scan Shows Cotton Wool Spots and Nerve Swelling (on Left)00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 640 views6 week fu - CWS are Fading00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 680 views6 week fu - CWS are Fading00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 733 viewsElschnig Spots are pigment spots in periphery00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 939 viewsElschnig Spots are pigment spots in periphery00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 1224 viewsElschnig Spots00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 1354 viewsElschnig Spots00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 711 views6 week fu - CWS are Fading00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 427 views6 week fu - CWS are Fading00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 399 views6 week fu - CWS are Fading00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema (NFL Scan - Black Line this visit, Gray line 6 weeks ago)427 viewsNerve Swelling is Less00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 389 viewsNerve Swelling is less00000
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Malignant Hypertension - Cotton Wool Spots - Elschnig Spots - Optic Nerve Edema 434 views6 week fu - CWS are Fading00000
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56-year-old man was seen in the office on March 11, 2013. He was hospitalized for five days a few weeks ago for increased high blood pressure. He said when he was hospitalized he is not sure, but his systolic blood pressure was in the high 200s and the diastolic pressure was in the mid 100s. His vision is reasonable in both eyes. He is not noticing any pain or discomfort. VISUAL ACUITY: OD 20/25, OS 20/20. IOP: 9 OU. SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There are 2+ cotton wool spots on the macula. OS: Vertical C/D ratio is 0.1. There is 1+ optic nerve edema and 2+ cotton wool spots. SPECTRALIS-SD-OCT SCAN: The nerve fiber layer scan shows thickening of the nerve fiber layer in both eyes. The average thickness in the right eye is 109 microns with thickening of the superior and inferior pole. The left eye has 133 microns with thinning of the superior, but thickening of the inferior pole of the nerve. COLOR PHOTOS: The photos show the cotton wool spots in the macula of both eyes. IMPRESSION: 1. HYPERTENSIVE RETINOPATHY – BOTH EYES WITH COTTON WOOL SPOTS AND OPTIC NERVE EDEMA DISCUSSION: I explained to the patient that he does have manifestations of hypertensive retinopathy in both eyes. Generally when the blood pressure is controlled, the retina normalizes, but he may end up with a little bit of optic atrophy depending on how severe the ischemic insult to the eye was. I asked him to return for a check in six weeks so I can repeat some of the testing.