Clinical signs

Almost always bilateral if unilateral –suspect carotid artery obstruction on the unaffected eye sparing the retina from the effects of hypertension

1. Narrowing of retinal arteriolae Retinal arteriolar sclerosis-thickening of the vessel wall (“copper” and “silver” wiring
2. Arterial microaneurisms
3. Arteriovenous crossing changes –Salus, Gunn sign (arteriovenous nipping)
4. Flame-shaped retinal haemorrhages
5. Cotton-wool spots
6. CRVO or BRVO
7. Hard exudates in the macula (“macular star”)
8. Focal chorioretinal atrophy (Elschnig spots)

Classification (grading of atherosclerosis)
Note in the elderly arteriosclerosis usually complicates the picture and prevents full demonstration of hypertensive signs

Grade 1
Mild generalised arteriolar attenuation (mostly small branches)

Grade 2
1. Obvious generalised narrowing of arteriolae
2. Deflection of veins at arteriovenous crossings (Salus sign)

Grade 3
1. “Copper” wiring artelioles
2. Tapering of veins on either side of the crossings (Gunn sign)
3. Right angle deflection of veins

Grade 4
1. See Grade 3 changes
2. “Silver” wiring of arterioles

Management

1. Dilated fundus examination
2. Blood pressure check
3. Control the hypertension
4. Follow up every 2-3months, then 6-12 months