Bilateral exudative multifocal retinal detachment: An unusual presentation of accelerated hypertension with obstructive uropathy

Gayatri Kanungo,Gullapalli N Rao ,Arttatrana Pal,Suresh C Dash

doi:10.5348/ijcri-2011-12-74-cr-4

Gayatri Kanungo, Gullapalli N Rao + Show 2 more

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https://doi.org/10.5348/ijcri-2011-12-74-cr-4

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Abstract

We report a case of accelerated hypertension with obstructive uropathy presenting with four days history of headache and profound loss of vision due to exudative retinal detachment, macular ischemia and bilateral hypertensive choroidopathy in young adult. A 27-yr-old male presented with bilateral vision loss. A detailed ocular examination, fundus fluorescein angiography, abdominal ultra sound, cystoscopy, brain CT scan, and laboratory examinations were carried out. Physical examination was notable for a high blood pressure and the visual acuity was present in both eyes. Visual acuity was noted by hand movement and counting fingers at one meter distance in right eye and left eye respectively. Further examination revealed signs of intense headache, vomiting, irritability, and blood pressure of 220/130 mm of Hg. Fundoscopy showed bilateral arteriolar narrowing, retinal hemorrhages, cotton wool exudates, and bullous exudative retinal detachments. Fundus fluorescein angiography revealed macular ischemia and pinpoint leaks. His urinary bladder was distended and Cystoscopy discovered high bladder neck and bladder neck stenosis causing obstruction. Ultrasonography showed dilated ureters suggestive of obstructive uropathy causing chronic interstitial nephropathy and chronic renal failure stage III leading to hypertension. Treatment with antihypertensive therapy over the next four months resulted in improvement in systemic blood pressure and subsided retinal detachment. Subsequently, the high bladder neck obstruction was relieved by appropriate urologic intervention. This case report highlights the clinical presentation of accelerated hypertension with obstructive uropathy which is rare and the importance for ophthalmologists in first detecting the accelerated hypertension which led to successful recovery with treatment of antihypertensives.

Highlights

We report a case of accelerated hypertension with obstructive uropathy presenting with four days history of headache and profound loss of vision due to exudative retinal detachment, macular ischemia and bilateral hypertensive choroidopathy in young adult
We present a patient with accelerated hypertension with obstructive uropathy presenting with progressive loss of vision of four days duration
In our case the patient presented with bilateral exudative retinal detachment which led to the diagnosis of obstructive uropathy with secondary hypertension within four days duration

Summary

INTRODUCTION

Ocular damage due to accelerated hypertension or malignant hypertension is a wellestablished phenomenon. Bilateral exudative multifocal retinal detachment is a rare presentation of accelerated hypertension. We present a patient with accelerated hypertension with obstructive uropathy presenting with progressive loss of vision of four days duration. Loss of vision was associated with severe occipital headache, vomiting and irritability His visual acuity in right eye was perception of hand movement and in left eye was counting fingers at one meter distance. Blood pressure was noted to be 220/130 mm Hg. The patient was referred to the department of medicine for the cause of hypertension and further management. Funduscopy revealed small greyish scars with central pigmentation, representing healed infarcts of retinal pigment epithelium (figure 3 A, B)

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