This is a follow-up from our 2/4/22 post of a patient with malignant hypertension.
This 22YO male presented on 1/18/22 with subacute vision loss of 20/200 OD and 20/50 OS. Blood pressure was 169/135. Color imaging shows nerve fiber layer infarcts (cotton-wool spots) and mild inner retinal hemorrhages.
OCT scanning shows mostly outer macular edema emanating from the nerve, with foveal subretinal fluid.
Nine months later, the macular and OCT findings have mostly normalized. OCT scanning shows thinning with disorganization of retinal inner layers (DRIL) nasally OD.
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, the macular thickening is always worse nasally (as in our case), and is an important clinical clue for this diagnosis.
