LAUSR

A 58-year-old woman with hypertension presented at the emergency department. She had been experiencing dizziness and general fatigue for a few days, and her hypertension was not well controlled. Blood pressure was 280/92 mmHg, and other preliminary clinical characteristics were within normal limits. She was admitted for medication and close monitoring of vital signs. During admission, she complained of sudden onset bilateral blurry vision. Visual acuity was R:6/40 L:6/20. Relative afferent pupillary defect and anterior chambers were unremarkable. The appearance of the fundus, and optical coherence tomography (OCT) and fluorescein angiography scans, are shown in Figure 1. The diagnosis was severe hypertensive choroidopathy. Hypertensive choroidopathy typically occurs in an episode of acute, severe hypertension. Focal retinal pigment epithelial detachments may occur due to impaired circulation and occlusive and ischaemic changes of choroidal vessels. Extensive bilateral exudative retinal detachments may occur in severe cases such as the present one. Breakdown of the blood–retinal barrier with none of the typical symptoms of retinopathy or choroidopathy, such as cotton-wool spot and haemorrhage, can occur in patients with malignant hypertension and a rapidly elevated blood pressure. Treatment should centre on blood pressure management and observation for other end-organ diseases. Blood pressure was strictly controlled. Visual acuity improved to R:6/15 L:6/9. Her left macular became flat. Mild subretinal fluid (Figure 1D) remained in the right eye after 6 weeks. The patient is undergoing regular follow-up in the cardiovascular clinic for her high blood pressure.