Color fundus photography reveals multiple cotton-wool spots in both eyes and a few intraretinal hemorrhages. The branch retinal artery occlusion inferonasal to the fovea in the left eye results in a broader patch of retinal whitening, reflecting intraretinal edema. Early fluorescein angiography demonstrates retinal nonperfusion below the fovea, corresponding to the distribution of the occluded branch retinal artery. The late picture on the right shows multiple areas of vascular leakage due to focal ischemia. As one of the few places in the body where blood vessels can be visualized directly, the retina is a convenient window to systemic vascular conditions.
Hypertension causes characteristic blood vessels changes, mirroring the systemic vasculopathy.
Initially, hypertensive patients will exhibit blood vessel wall narrowing due to autoregulation. While hypertension increases the risk of myocardial infarction, stroke, and other conditions, it generally does not interfere with retinal function. While typical systemic hypertension rarely damages the retina directly, malignant hypertension can cause permanent visual disability. Affecting both the retinal and choroidal circulation, malignant hypertension can damage the retina by ischemia, leakage of photoreceptor-toxic materials, and bleeding. This case illustrates several features of retinopathy from malignant hypertension.