Hello and welcome to the zero to finals podcast.

My name is Tom and in this episode I'm going to be talking to you about hypertensive retinopathy.

And you can find written notes on this topic at zero definals.com slash hypertensive retinopathy

or in the ophthalmology section of the second edition of the zero

definals medicine book. And you can find flashcards and questions to train your knowledge

and help you remember the information for longer at members.0.0.0.com. So let's get straight into it.

Hypertensive retinopathy involves damage to the small blood vessels in the retina

resulting from high blood pressure.

The changes can happen slowly with chronic hypertension over a long period of time, or they can happen quickly

in response to malignant hypertension. Let's go through the features. Silver wiring, or copper

wiring, is where the walls of the arterials become thickened and sclerosed and they reflect more light on examination.

This makes them look like silver or copper wires.

Arteriovenous nipping or AV nipping is where the arterials cause compression of the veins

where they cross due to sclerosis and hardening of the arterials cause compression of the veins where they cross due to sclerosis and hardening

of the arterials. Cotton wool spots are caused by ischemia and infarction in the retina

causing damage to the nerve fibres. Hard exudates are caused by damaged blood vessels leaking lipids onto the retina.

Retinal hemorrhages are caused by damaged blood vessels rupturing and releasing blood into the retina.

Dot and blot hemorrhages occur deeper in the retina in the inner nuclear layer or the outer plexiform layer.

Flame hemorrhages occur in the nerve fibre layer.

And finally, papillodema is caused by ischemia in the optic nerve, resulting in optic nerve swelling or odema.

Let's talk about the Keith Wagner classification. The Keith Wagner classification is used to

classify hypertensive retinopathy. Stage one involves mild narrowing of the arterials. Stage 2 involves focal constriction of

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