Arteriovenous (AV) nicking is a sign of hypertensive retinopathy that can lead to vision loss and other complications. It can be identified through an ophthalmologic exam and may precede an occlusion. High blood pressure is usually the cause and can be treated through lifestyle changes and medication. Advanced hypertensive retinopathy may have additional signs and other complications.
Arteriovenous (AV) nicking is a phenomenon seen in the eye, usually in association with hypertensive retinopathy. Patients with this condition experience damage to the retina due to chronic high blood pressure. If it isn’t addressed, they could be at risk of vision loss and other serious complications, such as heart problems caused by sustained high blood pressure. An ophthalmologic exam may show signs of AV nicks, also known as Gunn’s sign, and photos may be taken for recording or for evaluation by another healthcare professional.
In this clinical sign, where one of the venules in the eye crosses an arteriole, the venule has a bulging hourglass-shaped appearance. There are a number of theories to explain this phenomenon, including physical compression from thickened artery walls and the cellular changes that can occur with chronic hypertension. Whatever the cause, it can precede an occlusion, in which the venule is partially blocked and cannot carry blood. This exposes the patient to the risk of serious complications.
Examination of the eye to identify the AV notch can be done by introducing bright light through the pupil to visualize the retina and magnifying with the aid of a lens. The eye may be dilated to make it easier to see as much of the retina as possible, and injectable dyes may be used to enhance the contrast if your doctor thinks this may be helpful. Signs of AV notching are usually very easy to spot, thanks to the distinctive bumps. The images can help healthcare professionals monitor changes in the eye over time, which can be important if they want to assess response to treatment.
When AV blockage develops, this indicates that ongoing damage is occurring and that the patient needs to address the cause. High blood pressure is usually the culprit. Treatments may include changes in diet and exercise to determine if it is possible to lower blood pressure naturally. There are also medications available that may be recommended if the patient does not respond to initial treatment. High blood pressure can increase the risk not only of retinopathy, but also of glaucoma and damage to the optic nerve.
Patients with advanced hypertensive retinopathy typically have more signs than AV obstruction. These can include patches of cotton wool, areas of blurry vision across the eye, and blurred vision. Other clinical signs of high blood pressure, such as kidney damage and heart problems, may also be present.
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