Hypertensive Retinopathy - Chronic - Pheochromocytoma
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49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25. IOP: OD 16, OS 13.
SLIT EXAMINATION: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.4. There is no posterior vitreous separation. There is a mild hyperpigmented area inferior to the macula.
OS: Vertical C/D ratio is 0.4. There is no posterior vitreous separation. The macula looks normal.
OCT SCAN: The OCT scan from your office shows pigment epithelium thickening in the center of the right eye with subretinal fluid inferior to the fovea and some loss of photoreceptors. The left eye has a near normal scan. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows an area of irregular hyperfluorescence just inferior to the macula in the right eye, which stains in late frames but does not leak, nor does the nerve stain. There are patchy spots, which may be drusen or may be manifestations of his hypertensive retinopathy. The retinal vessels are irregular, both the arterials and the veins. The left eye similarly has patchy hyperfluorescence. There is a staining area inferior to the fovea and the retinal vessels are irregular and narrow.
IMPRESSION:
1. CHRONIC HYPERTENSIVE RETINOPATHY – BOTH EYES
2. CHRONIC SEROUS MACULAR DETACHMENT – RIGHT EYE
DISCUSSION: I explained to the patient that chronic high blood pressure can cause subretinal fluid to build up and can cause vision loss. He is working on getting his blood pressure under control, probably through surgical treatment of the pheochromocytoma within the year and I am hopeful once his blood pressure normalizes the right macula will dry and at least there will be no further damage and possibly his vision will improve. I asked him to return here for a check in three months or sooner if he should notice a problem and to see you back regularly.
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 953 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 747 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 1249 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 647 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 657 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 665 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 540 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 486 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 510 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 686 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 502 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 531 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 563 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 484 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 453 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 479 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 471 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 477 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 511 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 497 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 505 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Malevu 628 fois49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25.     (0 votes)
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49-year-old man chronic very high blood pressure sometimes the blood pressure will go as high as 260/160, sometimes it is 200/120 and sometimes it is 160/80. He has a pheochromocytoma on the adrenal gland and he has had vision loss in the right eye starting between three and four years ago.
VISUAL ACUITY: OD 20/60, OS 20/25. IOP: OD 16, OS 13.
SLIT EXAMINATION: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.4. There is no posterior vitreous separation. There is a mild hyperpigmented area inferior to the macula.
OS: Vertical C/D ratio is 0.4. There is no posterior vitreous separation. The macula looks normal.
OCT SCAN: The OCT scan from your office shows pigment epithelium thickening in the center of the right eye with subretinal fluid inferior to the fovea and some loss of photoreceptors. The left eye has a near normal scan. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows an area of irregular hyperfluorescence just inferior to the macula in the right eye, which stains in late frames but does not leak, nor does the nerve stain. There are patchy spots, which may be drusen or may be manifestations of his hypertensive retinopathy. The retinal vessels are irregular, both the arterials and the veins. The left eye similarly has patchy hyperfluorescence. There is a staining area inferior to the fovea and the retinal vessels are irregular and narrow.
IMPRESSION:
1. CHRONIC HYPERTENSIVE RETINOPATHY – BOTH EYES
2. CHRONIC SEROUS MACULAR DETACHMENT – RIGHT EYE
DISCUSSION: I explained to the patient that chronic high blood pressure can cause subretinal fluid to build up and can cause vision loss. He is working on getting his blood pressure under control, probably through surgical treatment of the pheochromocytoma within the year and I am hopeful once his blood pressure normalizes the right macula will dry and at least there will be no further damage and possibly his vision will improve. I asked him to return here for a check in three months or sooner if he should notice a problem and to see you back regularly.