Bilateral Exudative Retinal Detachment Secondary to Malignant Hypertension – A Case Report

Abstract

To report a case of bilateral exudative retinal detachment secondary to malignant hypertension. Hypertension has been identified as a major cause of morbidity and mortality across the world. A 29-year-old female presented with sudden onset painless loss of vision in both eyes since a day. Known case of hypertension for 6 months on irregular medication. On examination vision of the right eye was hand movement with no pinhole improvement, and on left eye it was counting finger 2 meter with no pin hole improvement. Intraocular pressure of both eyes was normal. Anterior segment examination of right eye was normal except relative afferent pupillary defect. Anterior segment of left eye was normal. Fundus examination - Bilateral disc swelling with inferior retinal detachment extending 4 to 7 clock hours with flame shaped haemorrhages and cotton wool spots over blood vessels with AV crossings with dull foveal reflex. OCT showed bilateral exudative detachment of sensory retina. BP -150/100 mmhg. Further investigation found to have acute renal failure, requiring urgent dialysis, and patient was started on dialysis. 3weeks after blood control was acheived ,visual acquity improved to 6/18 BE with exudative retinal detachment in both eyes resolved by its own except with few residual haemorrhages. Accelerated HTN may precipitate bilateral exudative retinal detachment in patient with acute renal failure in young adults. Bilateral exudative retinal detachment is a catostropic event which results in devastating vision loss within very short time span. Timely intervention may save the vision loss and renal failure. Keywords: Hypertensive retinopathy, Exudative retinal detachment, OCT