This 56YO male presented with two weeks of bilateral fuzzy vision. He gave a history of well-controlled hypertension and type 2 diabetes. Vision was 20/30 OD and 20/25 OS. Both optic nerves are swollen, and there are scattered intraretinal hemorrhages.
Blood pressure was 210/130. He was immediately sent to the nearest emergency room.
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 precipitated in the nasal macular outer plexiform layer.
