Hypertensive retinopathy Health Article

Definition

Hypertensive retinopathy is damage to the back part of the eye (retina) caused by high blood pressure.

Causes, incidence, and risk factors

High blood pressure can cause damage to blood vessels in the eyes. The higher the blood pressure and the longer it has been high, the more severe the damage is likely to be.

Your health care provider can see narrowing of blood vessels, and excess fluid oozing from blood vessels, with an instrument called an ophthalmoscope. The degree of retina damage (retinopathy) is graded on a scale of 1 to 4.

At grade 1, no symptoms may be present. Grade 4 hypertensive retinopathy includes swelling of the optic nerve and of the visual center of the retina (macula). Such swelling can cause decreased vision.

Other retinopathies that are known complications of high blood pressure are called:

• diabetic retinopathy
• ischemic optic neuropathy
• retinal artery occlusion
• retinal emboli
• retinal microaneurysm
• retinal vein occlusion

Symptoms

• Headaches
• Visual disturbances, and sometimes sudden vision loss

Signs and tests

• Blood pressure
• Fluorescein angiography
• Ophthalmoscopic examination, which can show changes even if you have no symptoms

Treatment

Control of high blood pressure (hypertension) is the only treatment for hypertensive retinopathy.

Expectations (prognosis)

Patients with grade 4 (severe hypertensive retinopathy) frequently also have heart and kidney complications of high blood pressure. The retina will generally recover well if the blood pressure is controlled, but some patients with grade 4 hypertensive retinopathy will have permanent damage to the optic nerve or macula.

Complications

• Complications associated with high blood pressure
• Irreversible damage to the optic nerve or macula, resulting in vision problems

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have high blood pressure and vision changes or headaches occur.

Prevention

Control of high blood pressure prevents changes in the blood vessels of the eye.

References

Klig JE. Ophthalmologic complications of systemic disease. Emerg Med Clin North Am. 2008 Feb;26(1):217-31, viii