Images in Clinical Medicine
Retinal Detachment in Malignant Hypertension
N Engl J Med 2009; 361:899August 27, 2009
- Article
A 37-year-old woman with no previous medical conditions presented with a 3-day history of headache and blurry vision. Her blood pressure was elevated, at 220/150 mm Hg, and visual acuity in both eyes was such that she could count fingers only and had sluggish pupil reactivity. Retinal examination revealed bilateral disk swelling with scattered cotton-wool spots (Panel A, arrow) and bilateral inferior serous retinal detachment (Panel B, arrow). Further workup revealed that the patient had renal disease, with a serum creatinine level of 14.9 mg per deciliter (1320 μmol per liter). She was treated with isosorbide dinitrate and amlodipine in addition to undergoing hemodialysis. One week later, her blood pressure was 140/90 mm Hg and her visual acuity had improved to 20/80 bilaterally. Funduscopy, performed while the pupils were dilated, showed resolution of the serous retinal detachment and a reduced number of cotton-wool spots and hard exudates. Two weeks after treatment, her vision had further improved to 20/30 in both eyes, with complete resolution of the retinal changes (Panel C). The patient is currently undergoing follow-up for renal failure. Severe hypertension can lead to subretinal fluid accumulation and exudative retinal detachment, which is a medical emergency, because it can lead to blindness.
Iqbal Tajunisah, F.R.C.S.
Dinesh Kumar Patel, M.S. (Ophthal.), M.S. (Ophthal.)
University of Malaya, Kuala Lumpur 50603, Malaysia
