Eye signs in systemic hypertension

Case presentation 1

A 31-year-old man presented to his GP after an optometrist noted retinal haemorrhages, cotton wool spots and hard exudates in both eyes during a routine examination. The GP considered that the changes were consistent with diabetic retinopathy, but a normal glucose tolerance test excluded this possibility. Referral to an ophthalmologist was then arranged.

At ophthalmology review, the patient had no visual symptoms. He was taking no medications and had no history of serious illness, but a past tendency to hypertension was evident. He had experienced a transient episode of hypertension related to a psoriasis treatment a few years ago, and he had been refused permission to donate blood because his blood pressure was ‘too high’ two months ago. His GP had followed the patient up after the most recent episode and found his blood pressure to be only mildly elevated (140/85 mmHg). No treatment for hypertension had been instituted.