Which ocular sign can indicate severe retinal damage from chronic hypertension?

Roth spots are indicative of severe retinal damage associated with chronic hypertension, particularly when there is compromised blood flow and resulting ischemia in the retinal layers. These spots are characterized by white-centered retinal hemorrhages and can occur due to various conditions involving systemic vascular abnormalities, including hypertension. They are believed to represent areas of hemorrhagic infarction with a central white area formed from the presence of platelets and fibrin, highlighting the underlying severe vascular compromise.

In the context of chronic hypertension, Roth spots can illustrate how the high blood pressure leads to long-term damage to the retinal vasculature, promoting conditions that result in these distinctive lesions. Recognizing Roth spots during an ocular examination may help eye care practitioners assess the systemic impact of hypertension and potentially prompt further investigation and management of the patient's overall health.

Cotton wool spots and angioid streaks may also appear in patients with systemic conditions, including hypertension, but they represent different pathological processes. Cotton wool spots are associated with localized retinal ischemia, while angioid streaks pertain to breaks in the Bruch's membrane often related to systemic diseases affecting the elastic tissue, such as pseudoxanthoma elasticum. Retinal detachment, while a serious complication, is not a direct indicator