1What are the current blood pressure categories?
Normal: <120 AND <80 mmHg; Elevated: 120–129 AND <80; Stage 1 HTN: 130–139 OR 80–89; Stage 2 HTN: ≥140 OR ≥90; Hypertensive crisis: >180 and/or >120.
2What is the hallmark retinal finding of hypertensive retinopathy?
Diffuseeneralized retinal arteriolar narrowing.
3What happens to the arteriole-to-venule (A:V) ratio in hypertensive retinopathy?
It decreases due to arteriolar narrowing; normal A:V ratio ≈ 2:3 (0.7).
4What causes acute vs chronic retinal vascular changes in hypertension?
Acute HTN → vasospasm/arteriolar constriction. Chronic HTN → arteriosclerosis with vessel-wall thickening.
5What is the progression of arteriolosclerotic vessel changes?
Grade I: generalized narrowing → Grade II: copper wiring → Grade III: silver wiring → Grade IV: opaque vessel.
6What causes copper and silver wiring?
Progressive thickening/sclerosis of the arteriolar wall alters the normal arteriolar light reflex.
7What is Gunn's sign?
Tapering of the vein on BOTH sides of an AV crossing (AV nicking).
8What is Salus' sign?
Deflection of the vein at an AV crossing, typically ≥90°.
9What is Bonnet's sign?
Dilation of the vein distal to an AV crossing.
10What type of retinal hemorrhage is most characteristic/prominent in hypertensive retinopathy?
Flame-shaped hemorrhages.
11Why do cotton-wool spots occur in hypertensive retinopathy?
Acute retinal ischemia from occlusion of terminal retinal arterioles.
12What classic macular finding can severe hypertensive retinopathy produce?
Macular star formed by hard exudates.
13What are the major fundus findings of severe/malignant hypertensive retinopathy?
Marked arteriolar narrowing + hemorrhages + CWS + hard exudatesetinal edema ± macular star + optic disc edema.
14What are the Keith-Wagener-Barker grades of hypertensive retinopathy?
Grade 0 = no detectable signs; Grade I = mild generalized arteriolar narrowing/sclerosis + vein concealment; Grade II = Grade I + focal arteriolar narrowing, AV nicking, moderate-marked sclerosis, exaggerated arterial light reflex + Salus sign; Grade III = Grade II + retinal hemorrhages, exudates, CWS + copper wiring, Gunn sign, Bonnet sign; Grade IV = Grade III + optic disc edema + silver wiring.
15What finding distinguishes Grade IV hypertensive retinopathy?
Optic disc edema.
16What vascular sign is associated with Grade I hypertensive retinopathy?
Vein concealment.
17What is Salus' sign and which hypertensive retinopathy grade is it associated with?
Deflection of the vein at an AV crossing; Grade II.
18What are Gunn's and Bonnet's signs and which hypertensive retinopathy grade are they associated with?
Gunn = tapering of the vein on either side of AV nicking; Bonnet = dilation of the vein distal to AV nicking; both associated with Grade III.
19What vessel appearance is associated with Grade III hypertensive retinopathy?
Copper wiring.
20What vessel appearance is associated with Grade IV hypertensive retinopathy?
Silver wiring.
21How can hypertensive retinopathy severity be simplified clinically?
Mild = Grades I–II; Moderate = Grade III; Severe = Grade IV with optic disc involvement.
22What should you do if hypertensive crisis with end-organ damage is suspected?
Immediate ER referral for systemic evaluation and controlled BP reduction.
23What major ocular diseases is systemic hypertension associated with?
CRVO/BRVO, CRAO/BRAO, retinal arterial macroaneurysm (RAM), and NAION.
24What patient is classic for a retinal arterial macroaneurysm (RAM)?
Elderly woman with systemic hypertension.
25What is a retinal arterial macroaneurysm (RAM)?
Dilation of a retinal arteriole; usually solitary and unilateral.
26Where are RAMs commonly located?
At/near AV crossings within the first 3 bifurcations of the posterior pole.
27What hemorrhage pattern suggests a ruptured RAM?
Multilevel hemorrhage → vitreous, preretinal, intraretinal and/or subretinal hemorrhage.
28What exudative pattern may surround a ruptured RAM?
Circinate hard exudates.
29What is the classic FA appearance of a RAM?
Hyperfluorescence of the dilated arteriole; surrounding blood causes blocked hypofluorescence.
30What are the clinical features of hypertensive optic neuropathy?
Optic disc edema, optic disc ischemia, and optic disc pallor.
31What retinal findings suggest CHRONIC hypertension?
AV crossing changes + copper/silver wiring from chronic arteriosclerosis.
32What findings suggest ACUTE/SEVERE hypertension?
Hemorrhages + CWS + retinal edema + hard exudates/macular star + especially optic disc edema.
33What is the primary treatment of hypertensive retinopathy?
Control systemic hypertension and coordinate care with the patient's medical provider.