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High blood pressure and eye disease
Definition
Hypertensive retinopathy is damage to the retina from high blood pressure. The retina is the layer of tissue at the back part of the eye. It changes light and images that enter the eye into nerve signals that are sent to the brain.
Alternative Names
Hypertensive retinopathy
Causes
High blood pressure can damage blood vessels in the retina. The higher the blood pressure and the longer it has been high, the more severe the damage is likely to be.
When you have diabetes, high cholesterol levels, or you smoke, you have a higher risk of damage and vision loss.
Rarely, a condition called malignant hypertension develops. Blood pressure readings suddenly become very high. Sometimes, the sudden rise in blood pressure can cause more severe changes in the eye.
Other problems with the retina are also more likely to occur, such as:
- Ischemic optic neuropathy -- damage to the nerves in the eye due to poor blood flow
- Retinal artery occlusion -- blockage of the blood supply in the arteries to the retina
- Retinal vein occlusion -- blockage of the veins that carry blood away from the retina
Symptoms
Most people with hypertensive retinopathy do not have symptoms until late in the disease.
Symptoms may include:
- Double vision or dim vision
- Headaches
- Visual disturbances, and sometimes sudden vision loss
Sudden symptoms are a medical emergency.
Exams and Tests
Using an instrument called an ophthalmoscope, your health care provider can see narrowing of blood vessels, and signs that fluid has leaked from blood vessels.
The degree of retina damage (retinopathy) is graded on a scale of 1 to 4:
- At grade 1, you may not have symptoms.
- In between grades 1 and 4, there are a number of changes in the blood vessels, leaking from blood vessels, and swelling in other parts of the retina.
- Grade 4 retinopathy includes swelling of the optic nerve and of the visual center of the retina (macula). This swelling can cause decreased vision.
Fluorescein angiography may be used to examine the blood vessels.
Treatment
Controlling high blood pressure is the only treatment for hypertensive retinopathy.
Outlook (Prognosis)
Patients with grade 4 (severe retinopathy) often have heart and kidney problems due to high blood pressure. They are also at higher risk for stroke.
The retina will generally recover if the blood pressure is controlled. However, some patients with grade 4 retinopathy will have permanent damage to the optic nerve or macula.
When to Contact a Medical Professional
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
Controlling high blood pressure prevents changes in the blood vessels of the eye, as well as in other organs like the heart, kidneys, and brain.
References
Kovach JL, Schwartz SG, Schneider S, Rosen RB. Systemic hypertension and the eye. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 16th ed. Philadelphia, Pa: Lippincott Williams & Wilkins;2012:chap 13.
Klig JE. Ophthalmologic complications of systemic disease. Emerg Med Clin North Am. 2008;26(1):217-231.
Rogers AH. Hypertensive retinopathy. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis Mo: Mosby Elsevier;2008:chap 6.15.
Reviewed By: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
