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Hypertensive Retinopathy - Chronic - Pheochromocytoma 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.
Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male962 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male753 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male1253 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male652 views49-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)
Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male663 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male674 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male548 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male488 views49-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)
Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male516 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male694 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male511 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male534 views49-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)
Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male572 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male488 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male458 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male490 views49-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)
Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male476 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male482 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male517 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male502 views49-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)
Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male515 views49-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)	Hypertensive Choroidopathy - Pheochromocytoma - Chronic Very High Blood Pressure 49 YO Male633 views49-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.