Retinopathy as a Differential Diagnosis
With regard to the recommendation to examine the ocular fundus in a “hypertensive emergency”, I wish to add that in severe hypertension it is not only retinopathy that may develop—ranging from vascular changes, hemorrhages, ischemic signs (cotton-wool spots), exudates, to serous retinal detachment. Schmieder also mentioned papillary swelling (1). This may look similar to papilledema, but typically, in increased intracranial pressure, this condition is not associated with retinopathy—as the most important differential diagnostic criterion. In malignant hypertension, choroidal infarctions—known as Elschnig’s spots—has been observed (2). Such chorioidal vascular disorder has also been found in experimentally triggered hypertension in monkeys (3, 4).
Prof. Dr. med. Dieter Schmidt
79106 Freiburg, Germany
Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
|1.||Schmieder RE: Endorgan damage in hypertension. Dtsch Arztebl Int 2010; 107(49): 866–73. VOLLTEXT|
|2.||Schmidt D, Löffler KU: Elschnig´s spots as a sign of severe hypertension. Ophthalmologica 1993; 206: 24–28. MEDLINE|
|3.||De Venecia G, Wallow I, Houser D, Wahlstrom M: The eye in accelerated hypertension. I. Elschnig´s spots in nonhuman primates. Arch. Ophthalmol 1980; 98: 913–918. MEDLINE|
|4.||Hayreh SS, Servais GE, Virdi PS, Fundus lesions in malignant hypertension. VI. Hypertensive choriodopathy. Ophthalmology 1986; 93: 1383–1400. MEDLINE|