This 43YO female was recently discharged from the hospital for severe hypertension. She told us she was hospitalized for about a month and a half, with treatment including a medically induced coma. Vision was 20/200 OU.
Color imaging shows bilateral retinal lipid extending from the maculas into the midperipheries. Swept source OCT shows bilateral central outer retinal thinning and scattered hyperreflective lipid extending from the outer plexiform layer to above the RPE.
When she returned 6 weeks later, vision remained at 20/200 OU, and the macular lipid was slowly regressing.
Learning Points:
Malignant hypertension, defined as blood pressure above 180 systolic and/or 120 diastolic, is a life-threatening medical emergency. Eye doctors are in a unique position to often diagnose this condition.
Patients will often present with bilateral optic nerve swelling, flame-shaped retinal hemorrhages, and, with more chronic disease, lipid precipitates in the nasal macular outer plexiform layer.
Since the macular fluid emanates from the optic nerve, macular lipid and thickening are virtually always worse nasally, which is an important clinical clue for this diagnosis.
