Introduction
Characterised by fibrinoid necrosis of the choroidal arteries, leading to areas of non-perfusion and outer retinal ischaemia.
- Signs of moderate hypertensive retinopathy and choroidopathy associated with 2-4x increase in risk of stroke, and 2x the risk of congestive heart failure.
- All hypertensive findings should be communicated to the GP
Dead Giveaways
The two main giveaways are typically seen on standard fundus photography
Elschnig Spots:
The ischaemia affected RPE will lead to small black dots surrounded by yellow hallows, which look hypo-AF on FAF
Elschnig Spots
Siegrist Streaks:
Ischaemia long tubules of the choroidal arterial vasculature are seen as streaks, usually due to hyperpigmentation following retinal necrosis
Siegrist Streak
diagnostic features
Systemic Associations:
RAO and RVO
Retinal artery Macroaneurysms
NAAION
Development and progression of DR, glaucoma or AMD
Circatricial Sequelae
Widespread choroid dysfunction can lead to a loss of RPE function. This can lead to breakdown of iBRB, inability to remove fluid, and leads to exudative retinal detachment
Can be associated with pre-eclampsia, renal failure, retinal artery stenosis, malignant hypertension.
Should be considered a medical emergency --> poor prognosis