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Review
. 2022 Jul 22;14(7):e27140.
doi: 10.7759/cureus.27140. eCollection 2022 Jul.

Malignant Hypertension and the Role of Ophthalmologists: A Review Article

Priyadarshini Mishra  1 , Nikita Dash  1 , Sandip K Sahu  1 , Vikas Kanaujia  2 , Kumudini Sharma  2
Affiliations
Review

Malignant Hypertension and the Role of Ophthalmologists: A Review Article

Priyadarshini Mishra et al. Cureus. .

Abstract

Malignant hypertension (MHT) is a sudden and severe increase in systemic blood pressure (BP) associated with advanced bilateral retinopathy. It comes under a broader term, called hypertensive emergency, where an acute rise in BP results in end-organ damage. The condition usually requires hospital admission and intensive care management. Although there are lots of sophisticated machines and laboratory tests present to diagnose various organ damage, the role of ophthalmologists will still be at the top. A record of the acute rise of BP to a defining level and simple ophthalmoscopy with high clinical suspicion can save a patient's life and preserve target organ function by timely referral. So, every ophthalmologist should be aware of this dangerous condition. In this review, we have tried to compile all the current knowledge regarding malignant hypertension that an ophthalmologist may require in day-to-day practice.

Keywords: disc edema; hypertensive emergency; hypertensive retinopathy; macular star; malignant hypertension.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Typical fundus picture of malignant hypertensive retinopathy
Fundus picture of right and left eye of a 21-year-old male patient (author's own patient) showing the typical signs of malignant hypertensive retinopathy like bilateral disc edema, peripapillary splinter haemorrhages, cotton wool spots, vascular tortuosity, venous engorgement, hard exudates at macula in form of macular star.
Figure 2
Figure 2. Fundus picture of a patient with malignant hypertension
Fundus picture of right and left eyes of a 16-year-old male patient (author's own patient) showing signs of malignant hypertensive retinopathy like bilateral disc edoema, few cotton wool spots and splinter haemorrhages, venous congestion and tortuosity. Elschnig spots and exudative retinal detachment are present inferiorly as signs of severe choroidopathy.
Figure 3
Figure 3. Atypical fundus pictures of patients with malignant hypertension
Upper photos are fundus picture of a 41-year-old male patient (author's own patient) showing extensive subretinal fibrinous exudates inferiorly along with superficial haemorrhages and minimal disc edema. Lower photos are fundus picture of a 27 years female patient with pre-eclampsia (author's own patient) showing signs of severe choroidopathy with fibrinous deposits at macula and Elschnig’s spots and exudative retinal detachment but no signs of retinopathy like haemorrhage, cotton wool spots or hard exudates.
Figure 4
Figure 4. Optical coherence tomography scan of macula in a patient with malignant hypertension
OCT macular scan of both eyes of a patient (author's own patient) with malignant hypertension showing bilateral nerve fibre layer thickening and wrinkling, subretinal fluid, cystoid macular edema, hyperreflective dots, disorganization of retinal outer layer
See this image and copyright information in PMC

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