Delhi Journal of Ophthalmology

A Tale of Hypertensive Retinopathy with Choroidopathy and Neuropathy in A Young Patient: A Sign of End Stage Renal Disease

Shruthy Vaishali Ramesh1, Prasanna Venkatesh Ramesh2, Ramesh Rajasekaran3, Meena Kumari Ramesh4,  Prajnya Ray5
1Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private limited, Trichy, India
2Department of Glaucoma and Research, Mahathma Eye Hospital Private limited, Trichy, India
3Department of Paediatric Ophthalmology and Strabismus, Mahathma Eye Hospital Private limited, Trichy, India
4Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private limited, Trichy, India
5Department of Optometry, Mahathma Eye Hospital Private limited, Trichy, India

Corresponding Author:

Prasanna Venkatesh Ramesh 
Mahathma Eye Hospital Private Limited, No 6, Tennur
Seshapuram, Tiruchirappalli, India
Email : email2prajann@gmail.com

Received: 15-OCT-2020

Accepted: 04-NOV-2020

Published Online: 09-JUL-2021

DOI:http://dx.doi.org/10.7869/djo.671

Abstract
A 35 year old male patient presented with defective vision in the left eye associated with severe headache for past one week. On evaluation, the best corrected visual acuity of right eye (OD) was 20/20 and left eye (OS) was 20/40. Fundus evaluation revealed features suggestive of hypertensive retinopathy, choroidopathy and neuropathy. His blood pressure was 210/140 mm of Hg. Furthermore, on referral to Nephrologist, the patient was diagnosed with renal hypertension and was started on dialysis. Ophthalmic evaluation helped in diagnosing this life-threatening systemic condition; and the possibility of choroidal lesions, though less recognised have important implications in end organ damage.

Keywords :Hypertensive Retinopathy, Hypertensive Choroidopathy, End Stage Renal Disease, Young Patient

A 35-year-old male patient presented with defective vision in the left eye (OS) associated with severe headache for past one week. On evaluation, the best corrected visual acuity (BCVA) of the right eye (OD) was 20/20 and left eye (OS) was 20/40.  Fundus evaluation revealed bilateral disc oedema, arteriolar narrowing, cotton wool spots, flame-shaped haemorrhages, multiple pigmentary epithelial detachments(PED) and exudative retinal detachment (RD)(Figure 1). His blood pressure was 210/140 mm of Hg. Furthermore, the patient was diagnosed with end stage renal failure due to renal hypertension and was started on dialysis. An ophthalmic evaluation may help diagnose life-threatening systemic conditions as seen in this case.1 They occur as a result of an acute hypertensive crisis, especially in young adults. It may present as focal choroidal infarcts seen as black spots surrounded by yellow haloes commonly known as Elschnig spots. Malignant hypertension causes undue stress on the choriocapillaris resulting in fibrinoid necrosis of the arterioles, and non-perfusion of the choriocapillaris due to the contraction of the flexible vessels.2 Clinically this presents as Siegrist streaks which are flecks arranged linearly along the vessels. Non-perfusion of choriocapillaris alters the retinal pigment epithelium (RPE) and can weaken its pump function which can cause a serous RD.3 Ophthalmologists should keep in mind the possibility of reno-vascular hypertension in young patients with hypertensive crises to get timely treatment.4 Choroidal lesions though less recognised have important implications in end-organ damage.5



References
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  2. Kishi S., Tso M.O.M., Hayreh S.S. Fundus lesions in malignant hypertension: I. A pathologic study of experimental hypertensive choroidopathy. Arch Ophthalmol. 1985;103(8):1189–1197.
  3. Gaudric A., Sterkers M., Coscas G. Retinal detachment after choroidal ischemia. Am J Ophthalmol. 1987;104(4):364–372
  4. Wijaya I, Siregar P. Hypertensive crises in the adolescent: evaluation of suspected renovascular hypertension. Acta Medica Indones. 2013 Jan;45(1):49–54. 
  5. Ugarte M, Horgan S, Rassam S, Leong T, Kon CH. Hypertensive choroidopathy: recognizing clinically significant end-organ damage. Acta Ophthalmol (Copenh). 2008 Mar;86(2):227–8.

CITE THIS ARTICLE

Ramesh SV, Ramesh PV, Rajasekaran R, Ramesh MK, Ray PA Tale of Hypertensive Retinopathy with Choroidopathy and Neuropathy in A Young Patient: A Sign of End Stage Renal Disease.DJO 2021;31:106-107

CITE THIS URL

Ramesh SV, Ramesh PV, Rajasekaran R, Ramesh MK, Ray PA Tale of Hypertensive Retinopathy with Choroidopathy and Neuropathy in A Young Patient: A Sign of End Stage Renal Disease.DJO [serial online] 2021[cited 2021 Jul 28];31:106-107. Available from: https://www.djo.org.in/articles/31/4/A-Tale-of-Hypertensive-Retinopathy-with-Choroidopathy-and-Neuropathy-in-A-Young-Patient.html