This patient presented with bilateral inner-retinal flame-shaped hemorrhages and nerve fiber layer infarcts. There was no past ocular or past medical history. In the office, her blood sugar was normal but her blood pressure was 160/92.
In this patient’s OCT, the macular fluid is coming mostly from the nerves; note the early nasal macular star OD and the bilateral outer retinal fluid on OCT that is most prominent nasally.
Angiography also shows a striking absence of macular leakage that should have been present if diabetes were the cause.
Although her blood pressure was not that severely elevated, we suspected it was likely much higher in the near past. She had no health coverage and no primary care doctor, so we sent her to the ER for further treatment and management.
Learning Points:
Hypertensive retinopathy can have a similar appearance to diabetic retinopathy. Clues to hypertensive cause include clinical, angiographic, and OCT signs.
Over time, patients with hypertensive retinopathy will develop near complete regression of all findings following systemic blood pressure treatment and control.
