The eye in accelerated hypertension. II. Localized serous detachments of the retina in patients

Hypertensive choroidopathy was noted in seven patients with accelerated or malignant hypertension. The acute lesion consisted of white areas of retinal pigment epithelial necrosis with overlying serous detachments of the retina. The detachments varied in size. Fluorescein staining of the damaged pigment epithelium and leakage into the subretinal space were demonstrated in several of these patients. Medical control of the BP resulted in a rapid disappearance of the detachment with minimal permanent ophthalmoscopic changes. Reperfusion of the choriocapillaris was suggested by the fluorescein angiogram. Patients with poor control of BP demonstrated at old sites of serous detachments more extensive retinal pigment epithelial pigmentary changes. Some lesions show a central hyperpigmented core surrounded by pigment atrophy (chronic Elschnig's spots). We suspect that choroidal vascular changes predominate when acute elevation of BP is present, whereas a more gradual onset of hypertension results in retinal vascular changes.