Hypertensive choroidopathy typically occurs in young patients who have experienced an episode of acute, severe hypertension often associated with preeclampsia, eclampsia, pheochromocytoma, or renal hypertension (see Chapter 9 for more on choroidal disease). Lobular nonperfusion of the choriocapillaris may occur, initially resulting in tan, lobule-sized patches that, in time, become hyperpigmented and surrounded by margins of hypopigmentation—lesions known as Elschnig spots (Fig 6-2). Linear configurations of similar-appearing hyperpigmentations known as Siegrist streaks follow the meridional course of choroidal arteries. Fluorescein angiography shows focal choroidal hypoperfusion in the early phases and multiple subretinal areas of leakage in the late phases (Fig 6-3). Focal retinal pigment epithelium (RPE) detachments may occur, and, in severe cases, extensive bilateral exudative retinal detachments may develop.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.